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General NPI Number Information
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NPI Number | 1760083851
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Entity Type | Individual
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Provider Name | THOMAS JAMES DESIMONE MS, ATC, LAT, PES
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Gender | Male
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Dates
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Enumeration Date | 11/04/2020
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Last Update Date | 01/20/2026
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Provider Practice Location Address
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Address Line | 1000 E UNIVERSITY AVE DEPT 3414
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City | LARAMIE
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State | WY
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Zip | 82071-2000
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Country | US
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Telephone | 307-766-2060
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Fax |
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Provider Business Mailing Address
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Address Line | 985 AUTUMN RIDGE RD
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City | MONTGOMERY
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State | AL
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Zip | 36117-6969
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Country | US
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Telephone | 203-448-6531
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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 | 2723
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License Number State | AL
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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 | 151
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License Number State | WY
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