Individual
MATTHEW LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
500 E COLLEGE ST, MARSHALL, MO 65340-3109
(660) 831-4195
(660) 831-4038
Mailing address
500 E COLLEGE ST, MARSHALL, MO 65340-3109
(660) 831-4195
(660) 831-4038
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2007032283
MO
Other
Enumeration date
04/30/2014
Last updated
04/30/2014
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