Individual
ALYSSA COLLEEN TENDALL STOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
215 5TH ST, MARIETTA, OH 45750-4033
(740) 376-4575
Mailing address
215 5TH ST, MARIETTA, OH 45750-4033
(515) 231-1327
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
AT005607
OH
225400000X
Rehabilitation Practitioner
AT005607
OH
2255A2300X
Athletic Trainer
AT005607
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AT005607
ATHLETIC TRAINER
OH
Enumeration date
10/21/2014
Last updated
02/11/2019
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