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General NPI Number Information
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NPI Number | 1336513241
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Entity Type | Individual
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Provider Name | ANTHONY VIDALI LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 11/17/2015
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Last Update Date | 12/13/2016
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Provider Practice Location Address
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Address Line | 642 S QUEEN ST SUITE 101
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City | DOVER
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State | DE
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Zip | 19904-3506
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Country | US
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Telephone | 302-724-6344
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Fax |
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Provider Business Mailing Address
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Address Line | 109 CEDAR LN
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City | CAMDEN
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State | DE
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Zip | 19934-1306
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Country | US
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Telephone | 815-529-9064
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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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