Individual
VAN TREECE WOODALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
1325 E FORTIFICATION ST, JACKSON, MS 39202-2442
(601) 354-4488
Mailing address
304 ROBB ST, SUMMIT, MS 39666-7167
(601) 248-9676
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000029947
MS
Other
Enumeration date
07/25/2017
Last updated
07/25/2017
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