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General NPI Number Information
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NPI Number | 1235189614
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Entity Type | Individual
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Provider Name | RICHARD STEPHEN TADDEI ATC
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Gender | Male
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4744 JAMES MADISON HWY FORK UNION MILITARY ACADEMY
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City | FORK UNION
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State | VA
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Zip | 23055
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Country | US
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Telephone | 434-842-4287
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Fax | 434-842-4299
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Provider Business Mailing Address
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Address Line | 11947 JAMES MADISON HWY
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City | PALMYRA
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State | VA
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Zip | 22963-4401
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Country | US
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Telephone | 434-589-4058
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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 | 0126000043
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License Number State | VA
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