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NPI Code Detail

MEDICARE: MR. BRETT VANFLEET ATC

MEDICARE: MR. BRETT VANFLEET 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 TrainerRT001905APA

General Provider Information

NPI Number : 1518923176
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRETT VANFLEET ATC
Provider Business Mailing Address
First Line : 2020 MAPLE RD
Second Line :
City : DALTON
State : PA
Zip : 18414-5000
Country : US
Telephone Number : 570-241-1191
Fax Number :
Provider Business Practice Location Address
First Line : 734 E LANCASTER AVE
Second Line :
City : VILLANOVA
State : PA
Zip : 19085-1325
Country : US
Telephone Number : 610-254-8001
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/24/2006
Last Update Date : 08/23/2011

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Directions to “ MR. BRETT VANFLEET ATC” Practice Location

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