Thomas Dannenberg, MAED, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

2014025141 Issued in MO

Practice address

209 S Kingshighway St
Saint Charles, MO 63301-1693

Phone

(618) 560-3298

NPI assigned

Apr 12, 2017

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1491955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686787200000",
    "number": "1255865754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 CORPORATE SQUARE DR STE 220",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631322938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 S KINGSHIGHWAY ST",
            "city": "SAINT CHARLES",
            "state": "MO",
            "postal_code": "633011693",
            "telephone_number": "618-560-3298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DANNENBERG",
        "first_name": "THOMAS",
        "credential": "MAED, LAT, ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-12",
        "last_updated": "2023-06-15",
        "certification_date": "2023-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MO",
            "license": "2014025141",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOARD OF CERTIFICATION",
            "identifier": "2000017249",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MISSOURI DIVISION OF PROFESSIONAL REGISTRATION",
            "identifier": "2014025141",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in Saint Charles, MO
• Providers in Saint Charles, MO by specialty
• Athletic Trainer in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.