=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598717670
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHERINE B PIROG ATC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1615 STANLEY ST KAISER HALL
-----------------------------------------------------
City | NEW BRITAIN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06050-2439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-832-3062
-----------------------------------------------------
Fax | 860-832-3169
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 459 FARMINGTON AVE
-----------------------------------------------------
City | NEW BRITAIN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06053-1967
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-229-8682
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number | 000006
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------