Individual
JILLIAN LEE AMBROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
417 GROW AVE, MONTROSE, PA 18801-1105
(814) 865-2725
Mailing address
16 ANDERSON RD, HARVEYS LAKE, PA 18618-2215
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
RT007668
PA
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/29/2018
Last updated
07/27/2022
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