Individual
BRENT THERIAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
392 S DONAHUE DR, AUBURN, AL 36849-5321
(334) 844-4750
Mailing address
18173 CHARTER AVE, PORT CHARLOTTE, FL 33954-1716
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1794
AL
Other
Enumeration date
04/24/2017
Last updated
04/24/2017
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