Individual
DANIEL WALLACE FOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
11130 PARKVIEW CIRCLE DR, FORT WAYNE, IN 46845-1735
(260) 445-3575
Mailing address
11130 PARKVIEW CIRCLE DR, FORT WAYNE, IN 46845-1735
(260) 445-3575
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36000038A
IN
Other
Enumeration date
03/16/2006
Last updated
03/03/2016
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