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Individual

MISS KYRA BUSQUE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LAT ATC

Contact information

Practice address
50 COLLEGE ST, KENDALL DANCE AND SPORTS COMPLEX ROOM 126A, SOUTH HADLEY, MA 01075-1423
(413) 538-3316
Mailing address
4 DOBSON RD, VERNON, CT 06066-5430
(860) 888-2789

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2934
MA

Other

Enumeration date
01/17/2017
Last updated
01/17/2017
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