Individual
MR. PATRICK LARRY
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1613 BURNING TREE DR, DECATUR, IL 62521-9151
(217) 865-2637
Mailing address
1613 BURNING TREE DR, DECATUR, IL 62521-9151
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
IL
Other
Enumeration date
09/20/2005
Last updated
07/08/2007
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