Provider Demographics
NPI:1043803752
Name:DEGLER, JARED WILLIAM (LAT ATC)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:WILLIAM
Last Name:DEGLER
Suffix:
Gender:M
Credentials:LAT ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 BERNE RD
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:PA
Mailing Address - Zip Code:19526-8910
Mailing Address - Country:US
Mailing Address - Phone:484-336-9956
Mailing Address - Fax:
Practice Address - Street 1:1 CIVIC CENTER PLZ
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06103-1504
Practice Address - Country:US
Practice Address - Phone:484-336-9956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
54.2255A2300X
CT54.0015022255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer