Individual
KRISTEN HENDERSON LASETA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
4060 WILDCAT BLVD, CHARLESTON, SC 29414-5851
(843) 573-1201
Mailing address
507 STINSON DR APT A6, CHARLESTON, SC 29407-6239
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
949
SC
Other
Enumeration date
06/22/2017
Last updated
06/22/2017
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