Individual
TIM WOODSTOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
2600 W MAIN ST, BELLEVILLE, IL 62226-6651
(618) 239-6386
Mailing address
8818 IONE LN, SAINT LOUIS, MO 63123-6422
(636) 667-7732
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2015028487
MO
Other
Enumeration date
04/11/2017
Last updated
04/11/2017
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