Dylan Church, LAT,ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

25MT00242600 Issued in NJ

Practice address

13 Goldsmith Dr
Spotswood, NJ 08884-1032

Phone

(908) 239-9392

NPI assigned

Aug 19, 2017

Last updated

Aug 19, 2017By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Infinite Athletic Training

  • Athletic Trainer
  • New Brunswick, NJ
  • NPI 1104515303
  NPD Authorized official
• Thryve Healing and Performance

  • Physical Therapy Clinic/Center
  • Ridgefield, NJ
  • NPI 1487390977
  NPD Authorized official
• Thryve Healing and Performance

  • Physical Therapy Clinic/Center
  • Colts Neck, NJ
  • NPI 1831843036
  NPD Authorized official

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

{
    "created_epoch": "1503100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1503100800000",
    "number": "1902322167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13 GOLDSMITH DR",
            "city": "SPOTSWOOD",
            "state": "NJ",
            "postal_code": "088841032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13 GOLDSMITH DR",
            "city": "SPOTSWOOD",
            "state": "NJ",
            "postal_code": "088841032",
            "telephone_number": "908-239-9392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHURCH",
        "first_name": "DYLAN",
        "credential": "LAT,ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-08-19",
        "last_updated": "2017-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NJ",
            "license": "25MT00242600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dominique Carlson
• Central Jersey Caring Dental
• Gloria Cerniglia, RPH
• Krista Stacey Chan, OTR/L
• Cheryl M Christopher
• Bonnie Cohen, PT
• Giovanna Conte, BCABA
• Samantha Linn Defilippo, PSY.D, NCSP, BCBA-D
• Kaitlin Deignan, LCSW LCADC
• Jacqueline Suzanne Dobres, MS OT R/L, BCBA

• Athletic Trainer in Spotswood, NJ
• Providers in Spotswood, NJ by specialty
• Athletic Trainer in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2017; 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.