Individual
MADELINE GRACE GANZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSAT STUDENT
Contact information
Practice address
701 E 17TH ST, BLOOMINGTON, IN 47408-1578
(812) 855-1966
Mailing address
701 E 17TH ST, BLOOMINGTON, IN 47408-1578
(812) 855-1966
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000870419
STUDENT ID
IN
Enumeration date
01/18/2023
Last updated
01/18/2023
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