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General NPI Number Information
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NPI Number | 1598396376
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Entity Type | Individual
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Provider Name | SEAN RICHARD ADAMS LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 01/30/2020
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Last Update Date | 01/30/2020
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Provider Practice Location Address
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Address Line | 14 SHARON AVE
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City | SETAUKET
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State | NY
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Zip | 11733-3942
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Country | US
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Telephone | 631-741-7934
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Fax |
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Provider Business Mailing Address
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Address Line | 250 UNIVERSITY AVE
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City | CALIFORNIA
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State | PA
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Zip | 15419-1341
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Country | US
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Telephone |
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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 | RTO000479
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License Number State | PA
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