Individual
JASON KYLE CARRUTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
550 CLUB LN, SUITE 2, CONWAY, AR 72034-3681
(501) 932-0814
Mailing address
68 DONNA KAY DR, GREENBRIER, AR 72058-9579
(501) 908-3117
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT 084
AR
Other
Enumeration date
07/14/2014
Last updated
07/14/2014
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