Individual provider · NPI-1

Sean Dougherty, ATC

Specialist/Technologist, Athletic Trainer · Lebanon, PA

NPI number1477157154
StatusActive
Last updated in NPPESNov 24, 2020

Details

NPI
1477157154
Entity type
Individual (NPI-1)
Name
Sean Dougherty
Credential
ATC
Sex
Male
Sole proprietor
Yes
Enumeration date
Nov 24, 2020
Certification date
Nov 24, 2020
Last updated
Nov 24, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
2255A2300X Specialist/Technologist, Athletic Trainer––Yes

Practice location

115 E Evergreen Rd
Lebanon, PA 17042-7596

Phone 717-272-2033

Mailing address

170 N Pointe Blvd
Lancaster, PA 17601-4132

Phone 717-299-4871

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