Individual
KELLY JO BAGNELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
23420 SUSANA AVE, TORRANCE, CA 90505-5430
(310) 367-0663
Mailing address
8 SAINT LUKES RD, ALLSTON, MA 02134-3100
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
01/29/2019
Last updated
05/21/2019
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