Individual
CHASE R STANLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
560 S LOOP RD, EDGEWOOD, KY 41017-3405
(859) 301-2663
Mailing address
933 HIGH KNOLL CT APT 148, VILLA HILLS, KY 41017-3644
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
PENDING
KY
Other
Enumeration date
08/13/2018
Last updated
08/13/2018
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