Individual
JAY MOMINEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAT
Contact information
Practice address
1000 MINERAL POINT AVE, JANESVILLE, WI 53548-2940
(608) 756-6000
Mailing address
1000 MINERAL POINT AVE, JANESVILLE, WI 53548-2940
(608) 756-6000
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
878
WI
Other
Enumeration date
03/19/2007
Last updated
07/08/2007
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