Active NPI
Keith Anthony Vanic, PHD, ATC, LAT
- Athletic Trainer
- Nazareth, PA
National Provider Identifier
1649798067
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- RT001357A
- Practice address
- 5992 Kesslersville Road
Nazareth, PA 18064 - Phone
- (484) 357-3396
- Fax
- (570) 422-3616
- NPI assigned
- Sep 6, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | RT001357A | PA | Primary |
Addresses
Primary practice location
5992 Kesslersville Road
Nazareth, PA 18064
Mailing address
5992 Kesslersville Rd
Nazareth, PA 18064-9374
Phone (484) 357-3396
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RT001357A | PA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1504656000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1649798067",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5992 KESSLERSVILLE RD",
"city": "NAZARETH",
"state": "PA",
"postal_code": "180649374",
"telephone_number": "484-357-3396",
"fax_number": "570-422-3616"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5992 KESSLERSVILLE ROAD",
"city": "NAZARETH",
"state": "PA",
"postal_code": "18064",
"telephone_number": "484-357-3396",
"fax_number": "570-422-3616"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANIC",
"first_name": "KEITH",
"middle_name": "ANTHONY",
"credential": "PHD, ATC, LAT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-09-06",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "PA",
"license": "RT001357A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Nazareth, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.