Individual
NATALIA SUMODJO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., LAT, ATC, CES
Contact information
Practice address
5200 NELSON RD APT 516, LAKE CHARLES, LA 70605-0810
(415) 259-1403
Mailing address
5200 NELSON RD APT 516, LAKE CHARLES, LA 70605-0810
(415) 259-1403
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
306799
LA
Other
Enumeration date
06/24/2018
Last updated
06/24/2018
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