Individual
TOMMY SOURIYAVONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC,LAT
Contact information
Practice address
110 BUBERNAK BLVD, OLD FORGE, PA 18518-1021
(570) 540-1178
Mailing address
110 BUBERNAK BLVD, OLD FORGE, PA 18518-1021
(570) 540-1178
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
06/09/2026
Last updated
06/09/2026
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