Individual
BRADLEY LAROSA
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
955 E TRAFFICWAY ST, SPRINGFIELD, MO 65802-3671
(618) 830-7511
Mailing address
1110 RUCKER LN, STAUNTON, IL 62088-4175
(618) 635-3527
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
20003027559
MO
2255A2300X
Athletic Trainer
96001870
IL
Other
Enumeration date
04/14/2006
Last updated
07/08/2007
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