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General NPI Number Information
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NPI Number | 1588843007
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Entity Type | Individual
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Provider Name | DAI SUGIMOTO ATC
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Gender | Male
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Dates
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Enumeration Date | 11/01/2007
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | W3718 SOUTH DR LAKELAND COLLEGE - ATHLETICS
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City | PLYMOUTH
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State | WI
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Zip | 53073-4878
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Country | US
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Telephone | 920-565-1510
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Fax |
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Provider Business Mailing Address
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Address Line | 150 BROWN STREET 2R
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City | WALTHAM
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State | MA
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Zip | 02453
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Country | US
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Telephone | 724-433-0778
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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 | 763-039
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License Number State | WI
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