Provider Demographics
NPI:1114792827
Name:GIAMPAOLI, MARC TIMOTHY (MA, ATC)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:TIMOTHY
Last Name:GIAMPAOLI
Suffix:
Gender:M
Credentials:MA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8468 RANCH RD
Mailing Address - Street 2:
Mailing Address - City:SUTTER
Mailing Address - State:CA
Mailing Address - Zip Code:95982-2370
Mailing Address - Country:US
Mailing Address - Phone:530-701-4338
Mailing Address - Fax:
Practice Address - Street 1:2665 ACACIA AVE.
Practice Address - Street 2:
Practice Address - City:SUTTER
Practice Address - State:CA
Practice Address - Zip Code:95982-9598
Practice Address - Country:US
Practice Address - Phone:530-822-5161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer