Individual
MR. JOHN K CAROLLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, LAT, ATC
Contact information
Practice address
8431 FREDERICKSBURG RD FL 5, SAN ANTONIO, TX 78229-3392
(210) 845-6458
Mailing address
8431 FREDERICKSBURG RD FL 5, SAN ANTONIO, TX 78229-3392
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
AT-1425
OH
2255A2300X
Athletic Trainer
Primary
AT1929
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
069802392
NATIONAL CERTIFICATION
—
01
—
AT-1425
ATHLETIC TRAINING LICENSE
OH
01
—
AT1929
ATHLETIC TRAINING LICENSE
TX
Enumeration date
06/17/2006
Last updated
10/01/2023
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