Individual
MISS MARTHA JANE ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
KUTZTOWN UNIVERSITY SPORTS MEDICINE, KUTZTOWN UNIVERSITY, KUTZTOWN, PA 19530-9446
(610) 683-4085
Mailing address
800 GOLDEN DR, APT C17, BLANDON, PA 19510-9446
(610) 944-1611
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
RT001363A
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RT001363A
STATE LICENSE #
PA
Enumeration date
02/27/2007
Last updated
07/08/2007
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