Individual
DANETTE LARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
414 N POTTER ST, GORMAN, TX 76454-7645
(254) 734-5196
Mailing address
PO BOX 125, GORMAN, TX 76454-0125
(254) 734-5196
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
40674922
TX
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/11/2022
Last updated
07/11/2022
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