Individual
MEGAN DETRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC,LAT,EMT-B
Contact information
Practice address
9142 FM 78, CONVERSE, TX 78109-2013
(210) 563-0402
Mailing address
12030 WOODSRIM ST, LIVE OAK, TX 78233-4243
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT5064
TX
Other
Enumeration date
12/06/2016
Last updated
12/06/2016
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