Individual
MS. ANTONIA ROSANNA LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MHSC, ATC, CEAS
Contact information
Practice address
5949 W RAYMOND ST, INDIANAPOLIS, IN 46241-4348
(317) 390-5590
Mailing address
3465 FIRST AVE, GROVE CITY, OH 43123
(502) 432-0620
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
002164
OH
Other
Enumeration date
06/30/2010
Last updated
06/30/2010
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