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General NPI Number Information
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NPI Number | 1215324066
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Entity Type | Individual
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Provider Name | KENNETH DOLAN ATC
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Gender | Male
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Dates
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Enumeration Date | 04/20/2015
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Last Update Date | 04/20/2015
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Provider Practice Location Address
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Address Line | 1419 SALT SPRINGS RD SPORTS MEDICINE DEPARTMENT
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City | SYRACUSE
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State | NY
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Zip | 13214-1302
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Country | US
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Telephone | 315-445-4417
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Fax |
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Provider Business Mailing Address
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Address Line | 116 GRAY AVE 2B
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City | SYRACUSE
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State | NY
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Zip | 13203-1414
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Country | US
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Telephone | 315-222-3644
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Fax |
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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 |
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License Number State |
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