Individual
MR. JAY JOSEPH DAVIDE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
LAT
Contact information
Practice address
820 E GRANT ST, APPLETON, WI 54911-3483
(920) 716-8137
Mailing address
1191 TRAILWOOD DR, DE PERE, WI 54115-1045
(920) 339-0233
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
164039
WI
Other
Enumeration date
04/03/2006
Last updated
07/08/2007
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