Individual
MR. JAY PATRICK ANDERSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1151 N STATE ST, ELGIN, IL 60123-1404
(847) 628-1592
(847) 628-1591
Mailing address
357 CORRINE AVE, CRYSTAL LAKE, IL 60014-5161
(815) 356-0456
(847) 628-1591
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
96000601
IL
Other
Enumeration date
11/14/2005
Last updated
07/08/2007
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