MEDICARE: SKYLAR SPITZ

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
1	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1639736507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SKYLAR SPITZ

Provider Business Mailing Address
First Line	:	126 WILLOWBROOK BLVD
Second Line	:
City	:	LEWISBURG
State	:	PA
Zip	:	17837-9343
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	126 WILLOWBROOK BLVD
Second Line	:
City	:	LEWISBURG
State	:	PA
Zip	:	17837-9343
Country	:	US
Telephone Number	:	717-582-6645
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2019
Last Update Date	:	07/10/2023

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Directions to “ SKYLAR SPITZ ” Practice Location

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