Individual
TIMOTHY AARON STANLEY FRACASSI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAT
Contact information
Practice address
28650 LAHSER RD, SOUTHFIELD, MI 48034-2020
(248) 789-1068
Mailing address
16935 W 12 MILE RD, SOUTHFIELD, MI 48076-2101
(248) 789-1068
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2601000720
MI
Other
Enumeration date
11/18/2014
Last updated
11/18/2014
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