Matthew Ray Rebuck, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

RT006257 Issued in PA

Practice address

1160 Manheim Pike
Lancaster, PA 17601-3127

Phone

(717) 903-0016

NPI assigned

Oct 22, 2015

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": "1445472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705449600000",
    "number": "1629440276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2088 POWDERHORN RD",
            "city": "MIDDLETOWN",
            "state": "PA",
            "postal_code": "170575971",
            "telephone_number": "717-903-0016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1160 MANHEIM PIKE",
            "city": "LANCASTER",
            "state": "PA",
            "postal_code": "176013127",
            "telephone_number": "717-903-0016"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8125 Adams Dr",
            "address_2": "Suite B",
            "address_purpose": "LOCATION",
            "city": "Hummelstown",
            "state": "PA",
            "postal_code": "170368625",
            "country_code": "US",
            "telephone_number": "717-220-2020",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "220 N Reach Rd",
            "address_purpose": "LOCATION",
            "city": "Williamsport",
            "state": "PA",
            "postal_code": "17701",
            "country_code": "US",
            "telephone_number": "717-903-0016",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REBUCK",
        "first_name": "MATTHEW",
        "middle_name": "RAY",
        "name_prefix": "Mr.",
        "credential": "LAT, ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-10-22",
        "last_updated": "2024-01-17",
        "certification_date": "2024-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "PA",
            "license": "RT006257",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2024; 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.