Provider Demographics
NPI:1902022148
Name:DORMANDY, GARY DAVID (ATHLETIC TRAINER)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:DAVID
Last Name:DORMANDY
Suffix:
Gender:M
Credentials:ATHLETIC TRAINER
Other - Prefix:
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Mailing Address - Street 1:1 KISH PLACE
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-3226
Mailing Address - Country:US
Mailing Address - Phone:203-697-2431
Mailing Address - Fax:203-697-2601
Practice Address - Street 1:333 CHRISTIAN STREET
Practice Address - Street 2:CHOATE ROSEMARY HALL
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492
Practice Address - Country:US
Practice Address - Phone:203-697-2431
Practice Address - Fax:203-697-2601
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT0001142255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer