Individual
ANTHONY MOON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
36460 22ND ST, KALAMAZOO, MI 49009-9200
(269) 547-9560
Mailing address
36460 22ND ST, KALAMAZOO, MI 49009-9200
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2601001211
MI
Other
Enumeration date
01/23/2017
Last updated
01/23/2017
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