Provider Demographics
NPI:1588843007
Name:SUGIMOTO, DAI (ATC)
Entity Type:Individual
Prefix:DR
First Name:DAI
Middle Name:
Last Name:SUGIMOTO
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 1:150 BROWN STREET
Mailing Address - Street 2:2R
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453
Mailing Address - Country:US
Mailing Address - Phone:724-433-0778
Mailing Address - Fax:
Practice Address - Street 1:W3718 SOUTH DR
Practice Address - Street 2:LAKELAND COLLEGE - ATHLETICS
Practice Address - City:PLYMOUTH
Practice Address - State:WI
Practice Address - Zip Code:53073-4878
Practice Address - Country:US
Practice Address - Phone:920-565-1510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI763-0392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer