Mark Daniel Grotzinger, ATC, PES

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

RT003823 Issued in PA

Practice address

Kenneth Langone Sports Medicine Center
One Dent Dr.
Lewisburg, PA 17837

Phone

(814) 418-0514

NPI assigned

Nov 20, 2006

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": "1163980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568851200000",
    "number": "1508930421",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 HAWTHORNE DR",
            "city": "LEWISBURG",
            "state": "PA",
            "postal_code": "178376659",
            "telephone_number": "814-418-0514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "KENNETH LANGONE SPORTS MEDICINE CENTER",
            "address_2": "ONE DENT DR.",
            "city": "LEWISBURG",
            "state": "PA",
            "postal_code": "17837",
            "telephone_number": "814-418-0514"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 LaSalle Sq",
            "address_purpose": "LOCATION",
            "city": "Providence",
            "state": "RI",
            "postal_code": "02903",
            "country_code": "US",
            "telephone_number": "401-680-4714",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GROTZINGER",
        "first_name": "MARK",
        "middle_name": "DANIEL",
        "name_prefix": "Mr.",
        "credential": "ATC, PES",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-20",
        "last_updated": "2019-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "PA",
            "license": "RT003823",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2019; 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.