Individual
BRYCE E ROARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAT, ATC
Contact information
Practice address
3301 BERRYWOOD DR, SUITE 204, COLUMBIA, MO 65201-6517
(573) 449-8771
(573) 449-6563
Mailing address
3301 BERRYWOOD DR, SUITE 204, COLUMBIA, MO 65201-6517
(573) 449-8771
(573) 449-6563
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2010031411
MO
Other
Enumeration date
05/16/2012
Last updated
03/18/2015
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