Individual
MAXIMILIAN MITA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1 COLLEGE ST, WORCESTER, MA 01610-2322
(508) 468-7612
Mailing address
1 COLLEGE ST, WORCESTER, MA 01610-2322
(508) 468-7612
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2903
MA
Other
Enumeration date
09/15/2016
Last updated
09/15/2016
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