Individual
BECKY BUBECK KLOSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
2903 UNRUH AVE, PHILADELPHIA, PA 19149-2527
(215) 332-1953
(215) 717-6238
Mailing address
2903 UNRUH AVE, PHILADELPHIA, PA 19149-2527
(215) 332-1953
(215) 717-6238
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
RT003492
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
991160
NATIONAL ATC
PA
01
—
RT003492
LICENSED ATHLETIC TRAINER
PA
Enumeration date
10/18/2006
Last updated
07/08/2007
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