Individual
TANNER JOSEPH COSTINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
1971 UNIVERSITY BLVD, LYNCHBURG, VA 24515-0002
(919) 622-0669
Mailing address
1007 SWIFT CREEK DR, CLAYTON, NC 27520-9809
(919) 622-0669
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
07/17/2020
Last updated
07/17/2020
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