Provider Demographics
NPI:1215309687
Name:PFEIFFER UNIVERSITY SPORTS MEDICINE
Entity type:Organization
Organization Name:PFEIFFER UNIVERSITY SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD ATHLETIC TRAINER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVITT
Authorized Official - Suffix:
Authorized Official - Credentials:LAT, ATC
Authorized Official - Phone:704-463-3216
Mailing Address - Street 1:PO BOX 960
Mailing Address - Street 2:MERNER GYMNASIUM
Mailing Address - City:MISENHEIMER
Mailing Address - State:NC
Mailing Address - Zip Code:28109
Mailing Address - Country:US
Mailing Address - Phone:704-473-3216
Mailing Address - Fax:704-463-5051
Practice Address - Street 1:48380 US-52
Practice Address - Street 2:
Practice Address - City:MISENHEIMER
Practice Address - State:NC
Practice Address - Zip Code:28109
Practice Address - Country:US
Practice Address - Phone:704-473-3216
Practice Address - Fax:704-463-5051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ000020848390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty