John Eugene Bistline III, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

RT006436 Issued in PA

Practice address

501 Darby Rd
Havertown, PA 19083-4702

Phone

(610) 675-9583

NPI assigned

Jun 28, 2016

Last updated

Jun 28, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1467072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467072000000",
    "number": "1255782587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 DARBY RD",
            "city": "HAVERTOWN",
            "state": "PA",
            "postal_code": "190834702",
            "telephone_number": "610-675-9583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 DARBY RD",
            "city": "HAVERTOWN",
            "state": "PA",
            "postal_code": "190834702",
            "telephone_number": "610-675-9583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BISTLINE",
        "first_name": "JOHN",
        "middle_name": "EUGENE",
        "name_suffix": "III",
        "credential": "LAT, ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-28",
        "last_updated": "2016-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "PA",
            "license": "RT006436",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in Havertown, PA
• Providers in Havertown, PA by specialty
• Athletic Trainer in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.