Provider Demographics
NPI:1477973360
Name:BORDIGNON, SCOTT (MS, ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:BORDIGNON
Suffix:
Gender:M
Credentials:MS, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2807 N GLEBE RD
Mailing Address - Street 2:DEPARTMENT OF ATHLETICS
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-4224
Mailing Address - Country:US
Mailing Address - Phone:610-908-9614
Mailing Address - Fax:
Practice Address - Street 1:2807 N GLEBE RD
Practice Address - Street 2:DEPARTMENT OF ATHLETICS
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22207-4224
Practice Address - Country:US
Practice Address - Phone:610-908-9614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-18
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260021332255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
39840OtherNATIONAL ATHLETIC TRAINERS ASSOCIATION - ATC
2000006599OtherNATIONAL ATHLETIC TRAINERS ASSOCIATION BOARD OF CERTIFICATION - ATC
201173394OtherNATIONAL STRENGTH AND CONDITIONING ASSOCIATION - CSCS
PART005079OtherLICENSE TO PRACTICE AS AN ATHLETIC TRAINER - STATE BOARD OF MEDICINE
VA0126002133OtherLICENSE TO PRACTICE AS AND ATHLETIC TRAINER - BOARD OF MEDICINE