Individual
ALEXANDER C MELLIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, ATC, LAT
Contact information
Practice address
COSTELLO ATHLETIC CENTER, 275 RIVERSIDE STREET, LOWELL, MA 01854
(978) 934-2373
Mailing address
COSTELLO ATHLETIC CENTER, 275 RIVERSIDE STREET, LOWELL, MA 01854
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000023944
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000023944
NATA BOARD OF CERTIFICATION, CERTIFIED ATHLETIC TRAINER
—
01
—
3249-AH-AT
COMMONWEALTH OF MASSACHUSETTS DIVISION OF PROFESSIONAL LICENSURE
MA
Enumeration date
01/13/2020
Last updated
01/13/2020
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