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Individual

ALTA FAISON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
6104 WHITEWAY DR, TEMPLE TERRACE, FL 33617-3105
(813) 382-1649
Mailing address
6104 WHITEWAY DR, TEMPLE TERRACE, FL 33617-3105

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary

Other

Enumeration date
09/23/2019
Last updated
09/23/2019
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