Individual
MISS MISTY SIOBHAN TATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MBA, LAT, ATC
Contact information
Practice address
4400 GOLF ACRES DR, BUILDING J SUITE D, CHARLOTTE, NC 28208-5990
(704) 774-7421
Mailing address
4749 CHARLESTON DR, CHARLOTTE, NC 28212-5514
(704) 747-5787
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1404
NC
Other
Enumeration date
02/01/2012
Last updated
02/01/2012
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