Individual
LAURISA RICHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
1 CAMPUS DR, ALLENDALE, MI 49401-9401
(616) 331-9385
Mailing address
430 STEPHEN ST, HUNTINGTON, IN 46750-2022
(260) 388-3408
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2601001760
MI
Other
Enumeration date
11/19/2017
Last updated
11/19/2017
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