Individual
MRS. MICHELLE LEE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
431 PINE ST STE G01, BURLINGTON, VT 05401-4726
(802) 272-7383
Mailing address
431 PINE ST STE G01, BURLINGTON, VT 05401-4726
(802) 272-7383
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
104-0000139
VT
Other
Enumeration date
02/20/2007
Last updated
07/11/2016
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