Provider Demographics
NPI:1841576170
Name:TRUESDELL, SEAN ANTHONY (ATC)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:ANTHONY
Last Name:TRUESDELL
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 1:24 SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:FREDON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-5318
Mailing Address - Country:US
Mailing Address - Phone:973-383-6700
Mailing Address - Fax:973-383-6951
Practice Address - Street 1:105 N CHURCH RD
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-3203
Practice Address - Country:US
Practice Address - Phone:973-383-6700
Practice Address - Fax:973-383-6951
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT001596002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer