Individual
COLLIN PATRICK GROVES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
644 PRAIRIE HILL AVE, MUKWONAGO, WI 53149-8932
(262) 891-7057
Mailing address
644 PRAIRIE HILL AVE, MUKWONAGO, WI 53149-8932
(262) 891-7057
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/09/2017
Last updated
03/09/2017
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