Individual
VINCENT FEDOROWICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSED, ATC
Contact information
Practice address
500 E COLLEGE ST, MARSHALL, MO 65340
(660) 831-4195
Mailing address
500 E COLLEGE ST, MARSHALL, MO 65340-3109
(660) 831-4195
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
0126001216
VA
2255A2300X
Athletic Trainer
Primary
2016033787
MO
Other
Enumeration date
05/08/2010
Last updated
06/19/2019
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