Individual
KRISTA HAIDLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
2400 JACKSON BLVD, COLUMBIA, SC 29207-7015
(412) 721-6473
Mailing address
19 LANDMARK DR APT 22E, COLUMBIA, SC 29210-4531
(412) 721-6473
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1069
SC
Other
Enumeration date
04/17/2020
Last updated
04/17/2020
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