Individual
RICHELLE VANWAGONER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, ATC, LAT
Contact information
Practice address
2600 N MILITARY TRL, ATHLETIC TRAINING, WEST PALM BEACH, FL 33409-2911
(561) 681-7931
(561) 681-7968
Mailing address
2600 N MILITARY TRL, ATHLETIC TRAINING, WEST PALM BEACH, FL 33409-2911
(561) 681-7931
(561) 681-7968
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AL3114
FL
Other
Enumeration date
11/13/2011
Last updated
05/01/2012
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