Healthcare Provider Details

I. General information

NPI: 1992746317
Provider Name (Legal Business Name): THOMAS DAVID BELMAGGIO JR. ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 KEANEY RD SUITE 1
KINGSTON RI
02881-1111
US

IV. Provider business mailing address

7 ROBERTSON RD
NARRAGANSETT RI
02882-5133
US

V. Phone/Fax

Practice location:
  • Phone: 401-255-3489
  • Fax:
Mailing address:
  • Phone: 401-255-9827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT00192
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: