Individual
CARRIE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AT
Contact information
Practice address
1600 23RD ST, BEDFORD, IN 47421-4704
(812) 275-2660
Mailing address
960 S ADAMS ST, APT 02, BLOOMINGTON, IN 47403-2139
(812) 275-2660
(812) 276-1304
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36001215A
IN
Other
Enumeration date
07/05/2006
Last updated
07/08/2007
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