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NPI Code Detail

MEDICARE: SCOTT BORDIGNON MS, ATC, CSCS

MEDICARE: SCOTT BORDIGNON MS, ATC, CSCS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer0126002133VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
139840OTHERNATIONAL ATHLETIC TRAINERS ASSOCIATION - ATC
22000006599OTHERNATIONAL ATHLETIC TRAINERS ASSOCIATION BOARD OF CERTIFICATION - ATC
3201173394OTHERNATIONAL STRENGTH AND CONDITIONING ASSOCIATION - CSCS
4RT005079OTHERPALICENSE TO PRACTICE AS AN ATHLETIC TRAINER - STATE BOARD OF MEDICINE
50126002133OTHERVALICENSE TO PRACTICE AS AND ATHLETIC TRAINER - BOARD OF MEDICINE

General Provider Information

NPI Number : 1477973360
Entity Type Code : Individual
Provider Name (Legal Business Name) : SCOTT BORDIGNON MS, ATC, CSCS
Provider Business Mailing Address
First Line : 2807 N GLEBE RD
Second Line : DEPARTMENT OF ATHLETICS
City : ARLINGTON
State : VA
Zip : 22207-4224
Country : US
Telephone Number : 610-908-9614
Fax Number :
Provider Business Practice Location Address
First Line : 2807 N GLEBE RD
Second Line : DEPARTMENT OF ATHLETICS
City : ARLINGTON
State : VA
Zip : 22207-4224
Country : US
Telephone Number : 610-908-9614
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2014
Last Update Date : 04/18/2014

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