Individual
JENELLE REILLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
97 STADIUM DR, ALAMOSA, CO 81101
(719) 587-8233
Mailing address
118 SAGE ST UNIT B, ALAMOSA, CO 81101-2975
(630) 346-7882
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000032712
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000032712
NATABOC
—
Enumeration date
02/11/2021
Last updated
02/22/2021
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