Individual
MR. WADSON PETITHOMME
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
290 MASSIE RD, CHARLOTTESVILLE, VA 22903-1767
(203) 726-0835
Mailing address
137 HILL ST, SHELTON, CT 06484-3238
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
CT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/19/2018
Last updated
05/22/2020
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