Individual
JUSTIN WIERENGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
620 MICHIGAN AVE NE, WASHINGTON, DC 20064-0001
(202) 319-6049
(202) 319-4752
Mailing address
243 14TH ST NE, APARTMENT 2, WASHINGTON, DC 20002-6413
(616) 706-1465
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
08/06/2014
Last updated
08/06/2014
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