Provider Demographics
NPI:1275753931
Name:VIGNEAULT, CHRISTOPHER L (ATC)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:L
Last Name:VIGNEAULT
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 GUILFORD PL
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-4186
Mailing Address - Country:US
Mailing Address - Phone:609-661-0405
Mailing Address - Fax:
Practice Address - Street 1:1570 BALTIMORE PIKE
Practice Address - Street 2:OFFICE OF SPORTS MEDICINE
Practice Address - City:LINCOLN UNIVERSITY
Practice Address - State:PA
Practice Address - Zip Code:19352
Practice Address - Country:US
Practice Address - Phone:484-365-7343
Practice Address - Fax:484-365-7614
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0038472255A2300X
NJ25MT001239002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer