Individual
MARY JO CUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS,LAT,ATC
Contact information
Practice address
3946 ICE WAY, FORT WAYNE, IN 46808
(419) 902-4973
Mailing address
3946 ICE WAY, FORT WAYNE, IN 46808
(419) 902-4973
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36001764A
IN
Other
Enumeration date
01/21/2014
Last updated
03/17/2018
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