Active NPI
Mark W Sarault, ATC,AT/L
- Athletic Trainer
- Glastonbury, CT
National Provider Identifier
1053659250
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- A160301117
- Practice address
- 2345 Main St
Glastonbury, CT 06033-2211 - Phone
- (860) 633-5572
- NPI assigned
- Jan 22, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | A160301117 | WA | Primary |
Addresses
Primary practice location
2345 Main St
Glastonbury, CT 06033-2211
Mailing address
223 116TH Ave NE
Lake Stevens, WA 98258-8628
Phone (317) 213-8532
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A160301117 | WA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1358812800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1358812800000",
"number": "1053659250",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "223 116TH AVE NE",
"city": "LAKE STEVENS",
"state": "WA",
"postal_code": "982588628",
"telephone_number": "317-213-8532"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2345 MAIN ST",
"city": "GLASTONBURY",
"state": "CT",
"postal_code": "060332211",
"telephone_number": "860-633-5572"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SARAULT",
"first_name": "MARK",
"middle_name": "W",
"credential": "ATC,AT/L",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-01-22",
"last_updated": "2013-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "WA",
"license": "A160301117",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glastonbury, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.