Individual
JANNA LYNN DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC/L
Contact information
Practice address
4401 W 52ND ST, INDIANAPOLIS, IN 46254-1701
(815) 690-4936
Mailing address
8227 NORTHWEST BLVD, 160, INDIANAPOLIS, IN 46278-1387
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36001765A
IN
Other
Enumeration date
11/09/2012
Last updated
11/09/2012
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