Provider Demographics
NPI:1184901050
Name:TRAYNOR, STEPHEN (ATC)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:TRAYNOR
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 1:293 CALEF RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-6474
Mailing Address - Country:US
Mailing Address - Phone:978-761-1106
Mailing Address - Fax:
Practice Address - Street 1:35 KOSCIUSZKO ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1608
Practice Address - Country:US
Practice Address - Phone:603-627-9728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH04682255A2300X
MA19082255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer