Healthcare Provider Details

I. General information

NPI: 1952363673
Provider Name (Legal Business Name): THOMAS M. MONAGAN JR. ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 DONAGHEY DEPARTMENT OF ATHLETICS - UNIV OF CENTRAL ARKANSAS
CONWAY AR
72034
US

IV. Provider business mailing address

3430 IRBY DR. APT. 312
CONWAY AR
72034-7313
US

V. Phone/Fax

Practice location:
  • Phone: 501-852-7749
  • Fax: 501-450-5087
Mailing address:
  • Phone: 814-490-2757
  • Fax: 501-450-5087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: