Individual
MIRANDA E SLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
525 FRANK THOMAS AVE APT 5, TUSCALOOSA, AL 35401-2265
(801) 326-9911
Mailing address
525 FRANK THOMAS AVE APT 5, TUSCALOOSA, AL 35401-2265
(801) 326-9911
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
AL
390200000X
Student in an Organized Health Care Education/Training Program
—
AL
Other
Enumeration date
03/29/2020
Last updated
03/29/2020
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