Individual
MRS. TIFFANY KAISER MCBRIDE
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
L-ATC
Contact information
Practice address
5050 N CLINTON ST, FORT WAYNE, IN 46825-5822
(419) 272-0012
Mailing address
11 212 STATE ROUTE 49, EDON, OH 43518
(419) 272-0012
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36001198A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36001198A
ATHLETIC TRIANER
IN
Enumeration date
04/11/2006
Last updated
07/08/2007
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