Individual
IVY VANESSA BANEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
504 UNIVERSITY BLVD, TUSCALOOSA, AL 35404
(301) 988-2762
Mailing address
504 UNIVERSITY BLVD, TUSCALOOSA, AL 35404
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
09/20/2019
Last updated
09/20/2019
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