Healthcare Provider Details

I. General information

NPI: 1235189614
Provider Name (Legal Business Name): RICHARD STEPHEN TADDEI ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4744 JAMES MADISON HWY FORK UNION MILITARY ACADEMY
FORK UNION VA
23055
US

IV. Provider business mailing address

11947 JAMES MADISON HWY
PALMYRA VA
22963-4401
US

V. Phone/Fax

Practice location:
  • Phone: 434-842-4287
  • Fax: 434-842-4299
Mailing address:
  • Phone: 434-589-4058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0126000043
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: