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Individual

MR. TANNER ALLEN KOCH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LAT/ATC

Contact information

Practice address
2810 BIRDIE LN, BRYANT, AR 72022-6740
(214) 476-2455
Mailing address
2810 BIRDIE LN, BRYANT, AR 72022-6740
(214) 476-2455

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AR

Other

Enumeration date
05/23/2018
Last updated
05/23/2018
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