Healthcare Provider Details

I. General information

NPI: 1619306073
Provider Name (Legal Business Name): JENNIFER DOMPIER L/ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 12/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11469 LITTLE ROCK CT
FISHERS IN
46037-3630
US

IV. Provider business mailing address

11469 LITTLE ROCK CT
FISHERS IN
46037-8448
US

V. Phone/Fax

Practice location:
  • Phone: 803-727-2527
  • Fax:
Mailing address:
  • Phone: 803-727-2527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number36002021A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: