Individual
GLENN EDGERTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
EDD, LAT
Contact information
Practice address
1705 N SAN FRANCISCO ST, FLAGSTAFF, AZ 86001-1348
(928) 523-6837
Mailing address
PO BOX 15094, FLAGSTAFF, AZ 86011-0543
(928) 523-6837
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1079
AZ
Other
Enumeration date
04/25/2017
Last updated
04/25/2017
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