Individual
ALYSSA L FREDERICKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
HWY 264 MILEPOST 388, UNIT 40, POLACCA, AZ 86042
(928) 737-0414
Mailing address
PO BOX 32, KYKOTSMOVI, AZ 86039-0032
(928) 514-3402
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
ATR-001676
AZ
Other
Enumeration date
10/26/2018
Last updated
10/26/2018
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