Individual
MISS SUSAN MARIE ANZALONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
901 S NATIONAL AVE, SPRINGFIELD, MO 65897-0027
(417) 836-5461
Mailing address
2601 N CRESTHAVEN AVE, H206, SPRINGFIELD, MO 65803-7826
(314) 494-1304
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2011005758
MO
Other
Enumeration date
03/24/2011
Last updated
03/24/2011
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