Individual
JAE HWAN SONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
640 DR MARY MCLEOD BETHUNE BLVD, HANDFILED ATHLETIC TRAINING CENTER, DAYTONA BEACH, FL 32114-3012
(386) 481-2261
Mailing address
1400 HANCOCK BLVD APT 1312, DAYTONA BEACH, FL 32114-5636
(619) 886-6597
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AL3738
FL
Other
Enumeration date
02/10/2015
Last updated
02/10/2015
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