Individual
MASON CONNOR MCMANIMON-MYERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT, DPT, ATC
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
15888-24
WI
2255A2300X
Athletic Trainer
2305
WI
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
12/04/2018
Last updated
05/02/2024
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