Individual
MR. AUSTIN MATLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
820 CHESTNUT ST, 115 JASON HALL, JEFFERSON CITY, MO 65101-3537
(573) 681-5331
Mailing address
2609A SOUTHRIDGE DR, JEFFERSON CITY, MO 65109-2069
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2011025934
MO
Other
Enumeration date
04/23/2014
Last updated
04/23/2014
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