Individual
MATTHEW LOUIS ENNIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
A.T.,C.
Contact information
Practice address
5840 26TH ST W, BRADENTON, FL 34207-3522
(941) 752-5574
Mailing address
4104 1ST AVE W, BRADENTON, FL 34209-2057
(941) 238-8592
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AL 796
FL
Other
Enumeration date
04/29/2008
Last updated
04/29/2008
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