Healthcare Provider Details

I. General information

NPI: 1871985465
Provider Name (Legal Business Name): CHARITY R SWEENEY ATC, LAT, CSCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2015
Last Update Date: 02/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 SANDERSON ST
GREENFIELD MA
01301-2778
US

IV. Provider business mailing address

18 HOWARD HEPBURN DR
SUNDERLAND MA
01375-9496
US

V. Phone/Fax

Practice location:
  • Phone: 920-639-9205
  • Fax:
Mailing address:
  • Phone: 920-639-9205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1695
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: