Individual
MR. JUSTIN ROBERT LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
2050 KENNY RD, COLUMBUS, OH 43221-3502
(614) 293-3600
Mailing address
2773 OAK FOREST DR, GROVE CITY, OH 43123-4737
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT002259
OH
Other
Enumeration date
05/04/2007
Last updated
07/08/2007
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