Healthcare Provider Details

I. General information

NPI: 1457344020
Provider Name (Legal Business Name): SCOTT RAY SAILOR EDD ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5275 N. CAMPUS DR. (M/S SG28)
FRESNO CA
93740-0001
US

IV. Provider business mailing address

5275 N. CAMPUS DR. (M/S SG28)
FRESNO CA
93740-0001
US

V. Phone/Fax

Practice location:
  • Phone: 559-278-2543
  • Fax: 559-278-7010
Mailing address:
  • Phone: 559-278-2543
  • Fax: 559-278-7010

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: