Healthcare Provider Details

I. General information

NPI: 1184699449
Provider Name (Legal Business Name): NEIL EVERETT DUVAL ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ST ANSELM DR BOX 1727
MANCHESTER NH
03102-1308
US

IV. Provider business mailing address

76 WESTERN AVE UNIT H2
HENNIKER NH
03242-3300
US

V. Phone/Fax

Practice location:
  • Phone: 603-641-7807
  • Fax:
Mailing address:
  • Phone: 603-428-4343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number100
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: