Healthcare Provider Details

I. General information

NPI: 1972637536
Provider Name (Legal Business Name): SONYA ANN COMINS ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PASHLEY DRIVE PER BUILDING STATE UNIVERSITY OF NEW YORK COLLEGE OF CORTLAND
CORTLAND NY
13045
US

IV. Provider business mailing address

99 TOMPKINS ST APT. 5
CORTLAND NY
13045-2450
US

V. Phone/Fax

Practice location:
  • Phone: 607-753-4602
  • Fax: 607-753-5929
Mailing address:
  • Phone: 607-753-8470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number000212-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: