Individual
MARISSA VANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC, LAT
Contact information
Practice address
1419 COMMONWEALTH AVE, APARTMENT 504, BOSTON, MA 02135-6253
(408) 398-5578
Mailing address
100 ENDICOTT ST, #3, BOSTON, MA 02113-1668
(408) 398-5578
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2446
MA
Other
Enumeration date
05/21/2014
Last updated
08/08/2014
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