1477973360 NPI number — SCOTT BORDIGNON MS, ATC, CSCS

Table of content: SCOTT BORDIGNON MS, ATC, CSCS (NPI 1477973360)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477973360 NPI number — SCOTT BORDIGNON MS, ATC, CSCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BORDIGNON
Provider First Name:
SCOTT
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, ATC, CSCS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477973360
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2807 N GLEBE RD
Provider Second Line Business Mailing Address:
DEPARTMENT OF ATHLETICS
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22207-4224
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-908-9614
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2807 N GLEBE RD
Provider Second Line Business Practice Location Address:
DEPARTMENT OF ATHLETICS
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22207-4224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-908-9614
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/18/2014

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:  0126002133 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 39840 . This is a "NATIONAL ATHLETIC TRAINERS ASSOCIATION - ATC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2000006599 . This is a "NATIONAL ATHLETIC TRAINERS ASSOCIATION BOARD OF CERTIFICATION - ATC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 201173394 . This is a "NATIONAL STRENGTH AND CONDITIONING ASSOCIATION - CSCS" identifier . This identifiers is of the category "OTHER".
  • Identifier: RT005079 . This is a "LICENSE TO PRACTICE AS AN ATHLETIC TRAINER - STATE BOARD OF MEDICINE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0126002133 . This is a "LICENSE TO PRACTICE AS AND ATHLETIC TRAINER - BOARD OF MEDICINE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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