Individual
MR. TERRY L DEZEEUW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
COLORADO STATE UNIVERSITY, MCGRAW ATHLETIC CENTER, FORT COLLINS, CO 80523-0001
(970) 491-6756
(970) 491-6167
Mailing address
COLORADO STATE UNIVERSITY, MCGRAW ATHLETIC CENTER, FORT COLLINS, CO 80523-0001
(970) 491-6756
(970) 491-6167
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36000536A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36000536A
STATE LICENSE
IN
Enumeration date
07/17/2006
Last updated
07/08/2007
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