Provider Demographics
NPI:1124161658
Name:SPERTZEL, ROBERT GEORGE (MS,ATC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:GEORGE
Last Name:SPERTZEL
Suffix:
Gender:M
Credentials:MS,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 SCHOFIELD DR
Mailing Address - Street 2:
Mailing Address - City:EAST BERLIN
Mailing Address - State:PA
Mailing Address - Zip Code:17316-9336
Mailing Address - Country:US
Mailing Address - Phone:717-259-0382
Mailing Address - Fax:
Practice Address - Street 1:104 SCHOFIELD DR
Practice Address - Street 2:
Practice Address - City:EAST BERLIN
Practice Address - State:PA
Practice Address - Zip Code:17316-9336
Practice Address - Country:US
Practice Address - Phone:717-259-0382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART000517A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer