Individual
AMANDA G. WACASEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1201 WESLEYAN ST, FORT WORTH, TX 76105-1536
(817) 629-8097
Mailing address
1201 WESLEYAN ST, FORT WORTH, TX 76105-1536
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000
NONE
—
Enumeration date
08/22/2018
Last updated
08/22/2018
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