Individual
KELLY QUACKENBUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5500 34TH ST W, BRADENTON, FL 34210-3506
(941) 739-7476
Mailing address
22830 COLLRIDGE DR, LAND O LAKES, FL 34639-4075
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AL3807
FL
Other
Enumeration date
10/10/2018
Last updated
10/10/2018
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