Individual
TREVOR LANE KISTLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAT, ATC
Contact information
Practice address
600 TX-349, IRAAN, TX 79744
(432) 639-2575
Mailing address
PO BOX 653, IRAAN, TX 79744-0653
(817) 721-2048
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT6983
TX
Other
Enumeration date
07/23/2020
Last updated
07/23/2020
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