Provider Demographics
NPI:1013012590
Name:CANNATA, STEVEN MARK (MS, ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:MARK
Last Name:CANNATA
Suffix:
Gender:M
Credentials:MS, ATC, LAT
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:29 RIVENDELL RD
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:CT
Mailing Address - Zip Code:06447-1260
Mailing Address - Country:US
Mailing Address - Phone:860-228-0210
Mailing Address - Fax:860-232-2095
Practice Address - Street 1:170 KINGSWOOD RD
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1430
Practice Address - Country:US
Practice Address - Phone:860-233-3500
Practice Address - Fax:860-232-2095
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0000652255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer