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Individual

MS. BRYNN ELISSA SCHUCKMAN

Active
Sole proprietor

Provider details

NPI number
Gender
F
Credential
LAT, ATC

Contact information

Practice address
107 S INDIANA AVE, BLOOMINGTON, IN 47405-7000
(812) 855-4509
Mailing address
806 WOODBRIDGE DR, BLOOMINGTON, IN 47408-2781
(501) 908-1050

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36001216A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
36001216A
LICENSED ATHLETIC TRAINER
IN
Enumeration date
02/10/2006
Last updated
07/08/2007
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