Individual
JACOB FARLEY TANNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, ATC, LAT
Contact information
Practice address
1054 TOWN AND FOUR PARKWAY DR, CREVE COEUR, MO 63141
(314) 803-7792
Mailing address
1054 TOWN AND FOUR PARKWAY DR, CREVE COEUR, MO 63141-6225
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2015026272
MO
Other
Enumeration date
07/19/2017
Last updated
08/03/2017
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