Individual
MR. WACEY JAMES MOONEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MHSC, ATC, LAT
Contact information
Practice address
2200 173RD ST, HAMMOND, IN 46323-2074
(219) 989-3175
Mailing address
2200 173RD ST, HAMMOND, IN 46323-2074
(219) 989-3175
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36002897A
IN
Other
Enumeration date
10/30/2017
Last updated
10/30/2017
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