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NPI Code Detail

MEDICARE: VICTORIA MARIE DIMATTIO

MEDICARE: VICTORIA MARIE DIMATTIO
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 Trainer
22255A2300XAthletic TrainerAT004261GA

General Provider Information

NPI Number : 1700368743
Entity Type Code : Individual
Provider Name (Legal Business Name) : VICTORIA MARIE DIMATTIO
Provider Business Mailing Address
First Line : 755 HANK AARON DR SW
Second Line :
City : ATLANTA
State : GA
Zip : 30315-1120
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 755 HANK AARON DR SW
Second Line :
City : ATLANTA
State : GA
Zip : 30315-1120
Country : US
Telephone Number : 208-571-5867
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2018
Last Update Date : 08/07/2024

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Directions to “ VICTORIA MARIE DIMATTIO ” Practice Location

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