Individual
AMANDA BOULWARE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
124 CONESTOGA ST, WINDSOR, CT 06095-2201
(786) 431-8888
Mailing address
124 CONESTOGA ST, WINDSOR, CT 06095-2201
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
000929
CT
Other
Enumeration date
10/02/2014
Last updated
10/02/2014
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