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General NPI Number Information
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NPI Number | 1124069026
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Entity Type | Individual
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Provider Name | LEONARD VINCENT FINAMORE JR. LATC, CSCS
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Gender | Male
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 05/15/2014
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Provider Practice Location Address
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Address Line | 235 BAKER ST
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City | WEST ROXBURY
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State | MA
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Zip | 02132-4331
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Country | US
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Telephone | 617-469-8080
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Fax | 617-325-0888
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Provider Business Mailing Address
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Address Line | 22 ABBOTT ST
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City | SOUTH WEYMOUTH
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State | MA
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Zip | 02190-1302
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Country | US
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Telephone | 781-331-8274
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Fax | 617-325-0888
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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 | 214
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License Number State | MA
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