Individual
DESTRY SPERFSLAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5525 SUMMERLAND DR, WATERLOO, IA 50701-9598
(563) 608-5650
Mailing address
5525 SUMMERLAND DR, WATERLOO, IA 50701-9598
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
076990
IA
Other
Enumeration date
12/22/2015
Last updated
12/22/2015
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