Healthcare Provider Details

I. General information

NPI: 1598317521
Provider Name (Legal Business Name): ALDEN FONTANA ATC, LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2019
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 MASSIE RD
CHARLOTTESVILLE VA
22903-1767
US

IV. Provider business mailing address

42 FRANKLIN ST
DUXBURY MA
02332-3204
US

V. Phone/Fax

Practice location:
  • Phone: 434-235-3446
  • Fax:
Mailing address:
  • Phone: 781-291-0447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0126003662
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: