Individual
KEVIN WILLIAM FORTIER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAT, ATC
Contact information
Practice address
1971 UNIVERSITY BLVD, LYNCHBURG, VA 24515-0002
(434) 582-3197
Mailing address
301 NORTHWYND CIR APT 204, LYNCHBURG, VA 24502-3415
(518) 586-2393
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0126002915
VA
Other
Enumeration date
07/06/2018
Last updated
07/06/2018
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