Individual
JAMIE PHEAP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1407 HARRIS AVE, MODESTO, CA 95351-2410
(209) 589-6292
Mailing address
1407 HARRIS AVE, MODESTO, CA 95351-2410
(209) 589-6292
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/03/2016
Last updated
08/03/2016
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