Individual
NICHOLAS CUSTAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AT ATC CSCS
Contact information
Practice address
1972 CLARK AVE, ALLIANCE, OH 44601
(330) 823-4105
Mailing address
1972 CLARK AVE, ALLIANCE, OH 44601-3929
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT.004418
OH
Other
Enumeration date
07/12/2017
Last updated
07/12/2017
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