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General NPI Number Information
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NPI Number | 1902297609
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Entity Type | Individual
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Provider Name | JULIE DUTTON X ATC
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Gender | Female
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Dates
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Enumeration Date | 02/17/2015
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Last Update Date | 02/17/2015
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Provider Practice Location Address
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Address Line | 586 MIDDLE TPKE E
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City | MANCHESTER
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State | CT
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Zip | 06040-3730
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Country | US
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Telephone | 860-645-3810
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Fax |
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Provider Business Mailing Address
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Address Line | 11 CINDY DR
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City | COVENTRY
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State | CT
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Zip | 06238-3469
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Country | US
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Telephone | 860-742-4428
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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 | 000634
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License Number State | CT
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