Individual provider · NPI-1
Giuseppi Bommarito Jr. I, ATC, LAT, BS
Specialist/Technologist, Athletic Trainer · Saint Peters, MO
NPI number1710007174
StatusActive
Last updated in NPPESJul 8, 2007
Details
- NPI
- 1710007174
- Entity type
- Individual (NPI-1)
- Name
- Mr. Giuseppi Bommarito Jr. I
- Credential
- ATC, LAT, BS
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Mar 30, 2007
- Last updated
- Jul 8, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2255A2300X | Specialist/Technologist, Athletic Trainer | 2004003803 | MO | Yes |
Practice location
4800 Mexico RdSuite 104
Saint Peters, MO 63376-1666
Phone 636-939-9540
Mailing address
612 Longhorn DrO Fallon, MO 63368-6934
Phone 636-939-9540
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