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NPI Code Detail

MEDICARE: JARED WILLIAM DEGLER LAT ATC

MEDICARE: JARED WILLIAM DEGLER LAT ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer54.
22255A2300XAthletic Trainer54.001502CT

General Provider Information

NPI Number : 1043803752
Entity Type Code : Individual
Provider Name (Legal Business Name) : JARED WILLIAM DEGLER LAT ATC
Provider Business Mailing Address
First Line : 65 BERNE RD
Second Line :
City : HAMBURG
State : PA
Zip : 19526-8910
Country : US
Telephone Number : 484-336-9956
Fax Number :
Provider Business Practice Location Address
First Line : 1 CIVIC CENTER PLZ
Second Line :
City : HARTFORD
State : CT
Zip : 06103-1504
Country : US
Telephone Number : 484-336-9956
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/12/2021
Last Update Date : 02/12/2021

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Directions to “ JARED WILLIAM DEGLER LAT ATC” Practice Location

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