Individual
KEITH WILLIAM MIESSAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
655 LONGWOOD LAKE MARY RD, LAKE MARY, FL 32746-3701
(407) 320-9753
Mailing address
1575 HUNTERS STAND RUN, OVIEDO, FL 32765-5100
(407) 619-0951
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AL 1930
FL
Other
Enumeration date
02/28/2006
Last updated
04/29/2008
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