Individual
JACQUELYNN ANN THREAT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
2725 W WIGWAM AVE, APT. 1108, LAS VEGAS, NV 89123-6603
(415) 533-4085
Mailing address
2725 W WIGWAM AVE, APT. 1108, LAS VEGAS, NV 89123-6603
(415) 533-4085
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0506166
NV
Other
Enumeration date
01/18/2012
Last updated
01/18/2012
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