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General NPI Number Information
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NPI Number | 1104515303
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Entity Type | Organization
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Legal Business Name | INFINITE ATHLETIC TRAINING
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Dates
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Enumeration Date | 05/03/2023
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Last Update Date | 05/03/2023
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Provider Practice Location Address
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Address Line | 38 TUNISON RD
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City | NEW BRUNSWICK
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State | NJ
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Zip | 08901-1633
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Country | US
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Telephone | 732-783-4973
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Fax |
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Provider Business Mailing Address
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Address Line | 38 TUNISON RD
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City | NEW BRUNSWICK
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State | NJ
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Zip | 08901-1633
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | GENERAL PARTNER
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Name | DYLAN CHURCH
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Credential | ATC
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Telephone | 732-783-4973
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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 |
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License Number State |
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