Individual
WAYNE THOMAS NORTHRUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
11350 PALMS BLVD, LOS ANGELES, CA 90066-2104
(310) 391-7127
Mailing address
11350 PALMS BLVD, LOS ANGELES, CA 90066-2104
(310) 391-7127
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
06/27/2006
Last updated
07/08/2007
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