Provider Demographics
NPI:1578524229
Name:WYSOCKI, MARC (ATC)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:
Last Name:WYSOCKI
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 N UNDERMOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01257-9638
Mailing Address - Country:US
Mailing Address - Phone:413-229-1296
Mailing Address - Fax:413-229-1109
Practice Address - Street 1:245 N UNDERMOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:SHEFFIELD
Practice Address - State:MA
Practice Address - Zip Code:01257-9638
Practice Address - Country:US
Practice Address - Phone:413-229-1296
Practice Address - Fax:413-229-1109
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9142255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer