Individual
ALLEN WAYNE MARDIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1490 DOUGLAS DR, MC 6620, CARBONDALE, IL 62901-4332
(570) 492-1784
(618) 453-4173
Mailing address
1490 DOUGLAS DR, MC 6620, CARBONDALE, IL 62901-4332
(570) 492-1784
(618) 453-4173
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
07/26/2007
Last updated
11/07/2013
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