Individual
ALYSSE POPOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1317 PROSPECT ST, INDIANAPOLIS, IN 46203-1940
(317) 654-7741
Mailing address
951 TECUMSEH ST, INDIANAPOLIS, IN 46201-1943
(317) 654-7741
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
000230
IN
2255A2300X
Athletic Trainer
Primary
BAF-APP23-00025
IN
Other
Enumeration date
09/06/2023
Last updated
09/18/2023
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