Individual
MRS. LISA ANN TATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
2312 S DIXON RD, SUITE 250, KOKOMO, IN 46902-6401
(765) 455-2122
(765) 455-3122
Mailing address
2312 S DIXON RD, SUITE 250, KOKOMO, IN 46902-6401
(765) 455-2122
(765) 455-3122
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36000648A
IN
Other
Enumeration date
08/15/2012
Last updated
08/15/2012
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