Individual
MR. JUSTIN LEE DRAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BS.MS.ATC.LAT
Contact information
Practice address
705 W 10TH ST, ROLLA, MO 65409-6520
(936) 552-1714
Mailing address
PO BOX 632, SAINT ROBERT, MO 65584-0632
(936) 552-1714
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT3725
TX
Other
Enumeration date
03/28/2007
Last updated
04/15/2009
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