Individual
MR. ABU IBRAHIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
201 TRUEBLOOD AVE, OSKALOOSA, IA 52577-1757
(641) 673-1093
(673) 641-1290
Mailing address
201 TRUEBLOOD AVE, OSKALOOSA, IA 52577-1757
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
001207
IA
Other
Enumeration date
01/22/2014
Last updated
01/22/2014
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