Individual
MR. MATTHEW FORTUNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAT, ATC
Contact information
Practice address
5705 SHATTALON DR, WINSTON SALEM, NC 27105-1332
(336) 399-5668
Mailing address
5705 SHATTALON DR, WINSTON SALEM, NC 27105-1332
(336) 399-5668
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2237
NC
Other
Enumeration date
06/13/2014
Last updated
06/13/2014
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