Provider Demographics
NPI:1427025543
Name:GAROFALO, ANTHONY JR (ATC)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:GAROFALO
Suffix:JR
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2902 EXETER CT
Mailing Address - Street 2:
Mailing Address - City:WEST DUNDEE
Mailing Address - State:IL
Mailing Address - Zip Code:60118-1724
Mailing Address - Country:US
Mailing Address - Phone:847-528-2841
Mailing Address - Fax:
Practice Address - Street 1:111 LIONS DR
Practice Address - Street 2:STE 212
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-3182
Practice Address - Country:US
Practice Address - Phone:847-381-0372
Practice Address - Fax:847-381-4529
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096-000023174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL096-000023OtherATHLETIC TRAINER