Provider Demographics
NPI:1861481129
Name:DOMPIER, KENNETH DONALD (ATC)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:DONALD
Last Name:DOMPIER
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 1:29 BUTTER JONES RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06412-1032
Mailing Address - Country:US
Mailing Address - Phone:860-685-3068
Mailing Address - Fax:
Practice Address - Street 1:FREEMAN ATHLETIC CENTER
Practice Address - Street 2:WESLEYAN UNIVERSITY
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06459-0001
Practice Address - Country:US
Practice Address - Phone:860-685-3068
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer