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General NPI Number Information
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NPI Number | 1710411236
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Entity Type | Individual
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Provider Name | JOHN JUNIET A.T.C., L.A.T.
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Gender | Male
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Dates
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Enumeration Date | 04/12/2017
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Last Update Date | 05/23/2022
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Provider Practice Location Address
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Address Line | 228 ELM ST
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City | MERIDEN
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State | CT
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Zip | 06450-5808
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Country | US
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Telephone | 203-499-8301
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Fax |
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Provider Business Mailing Address
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Address Line | 228 ELM STREET
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City | MERIDEN
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State | CT
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Zip | 06450
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Country | US
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Telephone | 203-499-8301
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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 | 405300000X
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Taxonomy Name | Prevention Professional
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License Number | 1215
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 1215
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License Number State | CT
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