Provider Demographics
NPI:1457332603
Name:BAGNALL, DONALD WILLIAM (ATC)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:WILLIAM
Last Name:BAGNALL
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9 STURBRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-1512
Mailing Address - Country:US
Mailing Address - Phone:203-389-5749
Mailing Address - Fax:203-389-2249
Practice Address - Street 1:986 FOREST RD
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06515-2501
Practice Address - Country:US
Practice Address - Phone:203-397-5749
Practice Address - Fax:203-389-2249
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer