Individual
LAURISSA SHORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1175 W LONG LAKE RD STE 101102, TROY, MI 48098-4438
(248) 245-8728
Mailing address
1175 W LONG LAKE RD STE 101102, TROY, MI 48098-4438
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
05/17/2023
Last updated
05/17/2023
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