Individual
MELISSA BRUNGARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
364 SENECA PLACE, SENECA, IL 61360
(217) 244-4921
Mailing address
364 SENECA PL, SENECA, IL 61360-9681
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096.003095
IL
Other
Enumeration date
10/22/2014
Last updated
05/11/2015
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