Individual
MISS TINA ELIZABETH SUNDERLAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
22 ASHLAWN AVE, MONTGOMERY, IL 60538
(630) 892-7709
Mailing address
22 ASHLAWN AVE, MONTGOMERY, IL 60538
(630) 892-7709
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
IL
Other
Enumeration date
03/09/2007
Last updated
07/08/2007
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