Individual
MICHAEL THOMAS MOLINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
125 COLLEGE DR, CASPER, WY 82601-4612
(307) 268-2259
Mailing address
2544 FAIRDALE AVE, CASPER, WY 82601-5157
(307) 247-2135
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
010
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010
ATHLETIC TRAINER
WY
01
—
96002362
ATHLETIC TRAINER
IL
Enumeration date
02/20/2007
Last updated
12/05/2011
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