Individual
DEREK L NISSLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1025 KOSER RD, MOUNT JOY, PA 17552
(717) 314-9537
Mailing address
1025 KOSER RD, MOUNT JOY, PA 17552-9288
(717) 314-9537
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
RT002083A
PA
Other
Enumeration date
11/01/2006
Last updated
11/30/2018
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