Individual
CAROLINE LISEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MED, ATC
Contact information
Practice address
1 IM SPORTS CIR, 308 W. CIRCLE DRIVE, EAST LANSING, MI 48824-1049
(862) 432-2171
Mailing address
105A STRIBLING AVE, CHARLOTTESVILLE, VA 22903-2940
(862) 432-2171
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0126002369
VA
Other
Enumeration date
06/29/2016
Last updated
06/29/2016
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