Individual
KENTA MIZUMOTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
720 SPORTS CENTER DR, LEXINGTON, KY 40506-1298
(859) 539-4746
Mailing address
720 SPORTS CENTER DR, LEXINGTON, KY 40506-0001
(859) 539-4746
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
11/02/2022
Last updated
05/18/2024
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