Individual
DEREK LOGAN MATTINGLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6221 WATERMARK DR APT 106, RIVERVIEW, FL 33578-3975
(859) 457-9190
Mailing address
6221 WATERMARK DR APT 106, RIVERVIEW, FL 33578-3975
(859) 457-9190
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
07/24/2019
Last updated
07/24/2019
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