Individual
JILL STRUBLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LAT, ATC
Contact information
Practice address
600 LEGACY PLZ W, LA PORTE, IN 46350-5268
(219) 362-8761
Mailing address
6100 S JOHN ST, NORTH JUDSON, IN 46366-8703
(937) 423-0722
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36002178A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060802297
BOARD OF CERTIFICATION
—
01
—
36002178A
INDIANA ATHLETIC TRAINERS BOARD
IN
Enumeration date
07/15/2014
Last updated
07/15/2014
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