Individual
KELVIN PHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSED, ATC, PES
Contact information
Practice address
263 ALDEN ST, SPRINGFIELD, MA 01109-3707
(713) 269-0120
Mailing address
194 LACONIA ST, SPRINGFIELD, MA 01129-1111
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2948
MA
Other
Enumeration date
05/27/2014
Last updated
01/13/2017
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