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Individual

CASEY FOUGEROUSSE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MS, ATC

Contact information

Practice address
2200 169TH ST, HAMMOND, IN 46323-2068
(812) 798-2920
Mailing address
11694 W STATE ROAD 48, JASONVILLE, IN 47438-6258
(812) 798-2920

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36002431A
IN

Other

Enumeration date
07/27/2016
Last updated
07/27/2016
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