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General NPI Number Information
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NPI Number | 1811545742
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Entity Type | Individual
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Provider Name | MR. ROSS ROBERT AIELLO IV
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Gender | Male
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Dates
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Enumeration Date | 09/04/2019
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Last Update Date | 09/04/2019
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Provider Practice Location Address
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Address Line | 1 FIELDHOUSE ROAD
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City | PLYMOUTH
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State | NH
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Zip | 03264
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Country | US
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Telephone | 603-728-7229
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Fax |
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Provider Business Mailing Address
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Address Line | 76 STICKNEY RD
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City | CAMPTON
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State | NH
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Zip | 03223-4948
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Country | US
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Telephone | 703-728-7229
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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 |
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License Number State | NH
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