Individual
PROF. TINA DEAN WAILGUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
601 MAIN ST., COLLEGEVILLE, PA 19426-1000
(610) 409-3000
Mailing address
4234 CREEK RD, COLLEGEVILLE, PA 19426-1115
(610) 454-1315
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
RT000191A
PA
Other
Enumeration date
04/06/2007
Last updated
07/08/2007
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