=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124902366
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HUNTER SARRO MAT, LAT, ATC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2025
-----------------------------------------------------
Last Update Date | 08/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 270 WINDCREST RD
-----------------------------------------------------
City | NORTH CLARENDON
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05759-9533
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-838-7859
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 5
-----------------------------------------------------
City | WALLINGFORD
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05773-0005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-838-7859
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number | 2000058351
-----------------------------------------------------
License Number State | VT
-----------------------------------------------------