Individual
MARY ELIZABETH BASTIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1730 S MILL AVE, TEMPE, AZ 85281-6600
(480) 967-1661
Mailing address
4950 E VAN BUREN ST APT 372, PHOENIX, AZ 85008-7054
(585) 743-0508
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
09/20/2020
Last updated
09/20/2020
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