Individual
MIZUE IWAMOTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, ATC, CSCS
Contact information
Practice address
110 8TH ST, TROY, NY 12180-3522
(518) 276-2884
Mailing address
110 8TH ST, TROY, NY 12180-3522
(518) 276-2884
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
002095
NY
Other
Enumeration date
02/18/2014
Last updated
01/27/2015
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