Individual
ELA COS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4638 RIVERSTONE BLVD, MISSOURI CITY, TX 77459-6157
(281) 969-7527
Mailing address
1518 RED HILLS DR, ROSHARON, TX 77583-3736
(954) 394-7279
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
05/23/2022
Last updated
05/23/2022
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