Individual
MISS LISA ANNE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, CSCS
Contact information
Practice address
8227 NORTHWEST BLVD, SUITE 160, INDIANAPOLIS, IN 46278-1387
(317) 415-5747
Mailing address
8640 INGALLS LN, CAMBY, IN 46113-8116
(317) 821-1668
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36000417A
IN
Other
Enumeration date
06/18/2007
Last updated
07/08/2007
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