Individual
MISS TIFFANY LYN LEBENGOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, ATC
Contact information
Practice address
MOORE AVENUE, BUCKNELL UNIVERSITY - KLARC, LEWISBURG, PA 17837
(570) 577-3049
(570) 577-1660
Mailing address
410 N 4TH ST, LEWISBURG, PA 17837-1106
(570) 523-0890
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
RT002024A
PA
Other
Enumeration date
10/24/2006
Last updated
07/08/2007
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