Individual
MR. MICHAEL R. DEROSIER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
DARTMOUTH COLLEGE, ALUMNI GYMNASIUM, HB 6083, HANOVER, NH 03755
(603) 646-9772
(603) 646-9941
Mailing address
1892 CHRISTIAN ST, WHITE RIVER JUNCTION, VT 05001-5402
(802) 295-1934
(603) 646-9941
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0360
NH
2255A2300X
Athletic Trainer
25MT00060500
NJ
Other
Enumeration date
12/13/2006
Last updated
05/20/2009
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