Individual
ANDREA RENEE BAGNALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
2934 W PALO VERDE ST, THATCHER, AZ 85552
(928) 651-4245
(928) 428-2378
Mailing address
2934 W PALO VERDE ST, THATCHER, AZ 85552-5336
(928) 651-4245
(928) 428-2378
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0248
AZ
Other
Enumeration date
04/29/2016
Last updated
04/29/2016
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