Individual
AUSTIN HILLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1655 E SAN MARNAN DR STE A, WATERLOO, IA 50702-4380
(319) 433-4750
Mailing address
1655 E SAN MARNAN DR STE A, WATERLOO, IA 50702-4380
(319) 433-4750
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
094584
IA
Other
Enumeration date
08/09/2021
Last updated
08/09/2021
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