1750419081 NPI number — ERICA THOMPSON BAUMGARTNER ATC

Table of content: ERICA THOMPSON BAUMGARTNER ATC (NPI 1750419081)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750419081 NPI number — ERICA THOMPSON BAUMGARTNER ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAUMGARTNER
Provider First Name:
ERICA
Provider Middle Name:
THOMPSON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THOMPSON
Provider Other First Name:
ERICA
Provider Other Middle Name:
LYNNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ATC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1750419081
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
527 WEST THAMES STREET
Provider Second Line Business Mailing Address:
UNIT 56
Provider Business Mailing Address City Name:
NORWICH
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
571-225-1411
Provider Business Mailing Address Fax Number:
860-429-0898

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13B DOG LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STORRS MANSFIELD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06268-2206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-429-0899
Provider Business Practice Location Address Fax Number:
860-429-0898
Provider Enumeration Date:
02/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X , with the licence number:  000144 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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