Provider Demographics
NPI:1467065391
Name:PAULIN, JARED RYAN (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:RYAN
Last Name:PAULIN
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 1:1150 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROWNDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18421-1200
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1150 MAIN ST
Practice Address - Street 2:
Practice Address - City:BROWNDALE
Practice Address - State:PA
Practice Address - Zip Code:18421-1200
Practice Address - Country:US
Practice Address - Phone:570-280-9507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-29
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
PART0079392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer