MEDICARE: MR. PATRICK JOHN STEIDLE ATC, CSCS

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	:	1992074264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PATRICK JOHN STEIDLE ATC, CSCS

Provider Business Mailing Address
First Line	:	1036 STATE ROUTE 307
Second Line	:
City	:	SPRING BROOK TOWNSHIP
State	:	PA
Zip	:	18444-6456
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1036 STATE ROUTE 307
Second Line	:
City	:	SPRING BROOK TOWNSHIP
State	:	PA
Zip	:	18444-6456
Country	:	US
Telephone Number	:	570-270-6432
Fax Number	:

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

Provider Enumeration Date	:	12/15/2011
Last Update Date	:	12/15/2011

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