Individual
MS. EBONY TARYN ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LAT, ATC
Contact information
Practice address
1585 3RD ST, FORT POLK, LA 71459-5102
(337) 531-3011
Mailing address
124 HINGE CHASE, CIBOLO, TX 78108-3375
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
AT005900
OH
2255A2300X
Athletic Trainer
Primary
AT8123
TX
Other
Enumeration date
01/22/2019
Last updated
10/11/2022
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