Basic Information
| Provider Information | |||||||||
| NPI: | 1861481129 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOMPIER | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | DONALD | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 29 BUTTER JONES RD | ||||||||
| Address2: | |||||||||
| City: | CHESTER | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064121032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606853068 | ||||||||
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| Practice Location | |||||||||
| Address1: | FREEMAN ATHLETIC CENTER | ||||||||
| Address2: | WESLEYAN UNIVERSITY | ||||||||
| City: | MIDDLETOWN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064590001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606853068 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | CT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.