Provider Demographics
NPI:1497877856
Name:CERCONE, RICHARD P (ATC, NHLAT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:P
Last Name:CERCONE
Suffix:
Gender:M
Credentials:ATC, NHLAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 EDGEWOOD RD RM 125A
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03824-1950
Mailing Address - Country:US
Mailing Address - Phone:603-862-1004
Mailing Address - Fax:603-862-4801
Practice Address - Street 1:5 EDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NH
Practice Address - Zip Code:03824-1950
Practice Address - Country:US
Practice Address - Phone:603-862-1004
Practice Address - Fax:603-862-4801
Is Sole Proprietor?:No
Enumeration Date:2007-04-05
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTAT 0001112255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer