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General NPI Number Information
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NPI Number | 1013012590
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Entity Type | Individual
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Provider Name | STEVEN MARK CANNATA M.S., ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 170 KINGSWOOD RD
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City | WEST HARTFORD
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State | CT
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Zip | 06119-1430
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Country | US
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Telephone | 860-233-3500
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Fax | 860-232-2095
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Provider Business Mailing Address
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Address Line | 29 RIVENDELL RD
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City | MARLBOROUGH
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State | CT
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Zip | 06447-1260
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Country | US
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Telephone | 860-228-0210
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Fax | 860-232-2095
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 000065
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License Number State | CT
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