Individual
MATTHEW NIESEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
7000 POWERS AVE, JACKSONVILLE, FL 32217-3318
(904) 708-7919
Mailing address
13494 SUNSTONE ST, JACKSONVILLE, FL 32258-5479
(904) 708-7919
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
224
HI
2255A2300X
Athletic Trainer
AL4715
FL
Other
Enumeration date
01/26/2015
Last updated
01/29/2020
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