Provider Demographics
NPI:1558712919
Name:SALVATORE, ANTHONY (MS, ATC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:SALVATORE
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 BRIDLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4558
Mailing Address - Country:US
Mailing Address - Phone:603-505-2014
Mailing Address - Fax:
Practice Address - Street 1:20 BRIDLEWOOD LN
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4558
Practice Address - Country:US
Practice Address - Phone:603-505-2014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0006832255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer