Provider Demographics
NPI:1518318518
Name:DATTILO, AARON FRANCIS (AT)
Entity Type:Individual
Prefix:MR
First Name:AARON
Middle Name:FRANCIS
Last Name:DATTILO
Suffix:
Gender:M
Credentials:AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1448 GATEWAY LAKES DR N
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-9369
Mailing Address - Country:US
Mailing Address - Phone:740-816-6343
Mailing Address - Fax:
Practice Address - Street 1:1448 GATEWAY LAKES DR N
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-9369
Practice Address - Country:US
Practice Address - Phone:740-816-6343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT.0049442255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer