Individual
MISS KELLEY LUCILLE WEIDINGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, LAT
Contact information
Practice address
3308 W EDGEWOOD DR STE F, JEFFERSON CITY, MO 65109-6891
(573) 638-3400
(573) 638-3405
Mailing address
11820 MARIES ROAD 328, VIENNA, MO 65582-7123
(573) 680-3826
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2007017252
MO
Other
Enumeration date
06/20/2007
Last updated
07/08/2007
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