Individual
MR. MICHAEL DISTEFANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, ATC, CSCS, PES
Contact information
Practice address
9 DOG LN, SUITE 108, STORRS, CT 06268-2239
(860) 429-0899
Mailing address
90 JONATHAN LN, STORRS MANSFIELD, CT 06268-2775
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
000608
CT
Other
Enumeration date
11/08/2016
Last updated
11/08/2016
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