Individual
KATRINA HALEY CARL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, LAT
Contact information
Practice address
98 POPLAR ST, BLACKFOOT, ID 83221-1758
(530) 635-7005
Mailing address
2509 EAGLE DR, AMMON, ID 83406-4919
(530) 635-7005
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-555
ID
Other
Enumeration date
03/08/2016
Last updated
03/08/2016
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