Individual
ETHAN TANNER AUSTELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2734 FORT AVE APT 218, LYNCHBURG, VA 24501-3368
(904) 607-1418
Mailing address
2734 FORT AVE APT 218, LYNCHBURG, VA 24501-3368
(904) 607-1418
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
VA
Other
Enumeration date
05/19/2025
Last updated
05/19/2025
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