Individual
DEREK ALAN HORNAMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
100 PEACH ST, ERIE, PA 16507-1423
(814) 860-4706
Mailing address
4725 CONRAD RD, ERIE, PA 16510-3815
(814) 282-6817
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
RT004489
PA
Other
Enumeration date
02/27/2018
Last updated
02/27/2018
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