Individual
MISS TIANA MCKIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
631 S COLLEGE AVE, NEWARK, DE 19716-2010
(302) 831-2196
Mailing address
631 S COLLEGE AVE, NEWARK, DE 19716-2010
(302) 831-2196
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1714469
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1714469
EXAMINING BOARD OF PHYSICAL THERAPISTS AND ATHLETIC TRAINERS
DE
Enumeration date
09/02/2016
Last updated
11/18/2019
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