Individual
MICHELLE FASANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AT, ATC
Contact information
Practice address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(847) 778-7280
Mailing address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
068
WY
2255A2300X
Athletic Trainer
096004795
IL
2255A2300X
Athletic Trainer
2402
NC
2255A2300X
Athletic Trainer
Primary
2601001564
MI
2255A2300X
Athletic Trainer
—
FL
Other
Enumeration date
11/29/2012
Last updated
10/16/2023
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