Individual
MR. MARK ELIZONDO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, LAT, ATC
Contact information
Practice address
301 W WABASH AVE STE A, CRAWFORDSVILLE, IN 47933-2484
(765) 361-6235
Mailing address
301 W WABASH AVE STE A, CRAWFORDSVILLE, IN 47933-2484
(765) 361-6235
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36000944A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080202029
NATIONAL ATHLETIC TRAINERS ASSOCIATION
—
Enumeration date
01/06/2023
Last updated
01/06/2023
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