1922125905 NPI number — MR. NEAL FREDERICK SAND ATC., CSCS

Table of content: MR. NEAL FREDERICK SAND ATC., CSCS (NPI 1922125905)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922125905 NPI number — MR. NEAL FREDERICK SAND ATC., CSCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAND
Provider First Name:
NEAL
Provider Middle Name:
FREDERICK
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
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:
1922125905
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:
71 ALLEN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILTON
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05468-3872
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-893-6724
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
140 PATRICK GYM
Provider Second Line Business Practice Location Address:
SPEAR STREET
Provider Business Practice Location Address City Name:
BURLINGTON
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05405-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-656-9573
Provider Business Practice Location Address Fax Number:
802-656-9578
Provider Enumeration Date:
03/23/2007

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:  1040000068 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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