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NPI Code Detail

MEDICARE: TIMOTHY DONOFRIO MS, ATC

MEDICARE:   TIMOTHY  DONOFRIO  MS, ATC
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 Trainer96000519IL

General Provider Information

NPI Number : 1619963642
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIMOTHY DONOFRIO MS, ATC
Provider Business Mailing Address
First Line : 806 W 75TH ST
Second Line :
City : NAPERVILLE
State : IL
Zip : 60565-6186
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 806 W 75TH ST
Second Line :
City : NAPERVILLE
State : IL
Zip : 60565-6186
Country : US
Telephone Number : 630-802-2296
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2005
Last Update Date : 07/08/2007

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Directions to “ TIMOTHY DONOFRIO MS, ATC” Practice Location

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