Individual
JESSIE BOLLBACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, LAT
Contact information
Practice address
3301 COLLEGE AVE, DAVIE, FL 33314-7796
(954) 336-9858
Mailing address
3301 COLLEGE AVE, DAVIE, FL 33314-7796
(954) 336-9858
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
07/22/2015
Last updated
02/11/2021
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