Individual
MICHELLE K HERTEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC, LAT
Contact information
Practice address
7601 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4133
(260) 436-6326
(260) 436-9063
Mailing address
7601 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4133
(260) 436-6326
(260) 436-9063
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36001508A
IN
Other
Enumeration date
03/05/2010
Last updated
03/05/2010
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