| NPI | 1083071807 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TEGAN MARIE HINAMAN Athletic Trainer 570-447-3010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0400X Clinic/Center Rehabilitation (Licence: SC 1530) |
| Enumeration Date | 2016-01-25 |
| Last Update Date | 2016-01-25 |