Individual
MRS. MARLI CAROLLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
637 N MAIN AVE, SAN ANTONIO, TX 78205-1203
(210) 834-0348
Mailing address
637 N MAIN AVE, SAN ANTONIO, TX 78205-1203
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT5471
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
069902740
NATIONAL CERTIFICATION
—
01
—
AT5471
ATHLETIC TRAINING LICENSE
TX
Enumeration date
06/28/2006
Last updated
12/31/2017
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