Individual
JESSE TITTLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
1100 REID PKWY, RICHMOND, IN 47374-1157
(765) 983-3092
Mailing address
204 N 5TH ST, RICHMOND, IN 47374-3013
(563) 357-1489
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
261106063
IN
2255A2300X
Athletic Trainer
AT003116
OH
Other
Enumeration date
10/17/2016
Last updated
10/17/2016
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