Individual
HOLLIS THEARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, LAT
Contact information
Practice address
49464 MERNER TERRACE, MISENHEIMER, NC 28109
(704) 463-0567
Mailing address
435 EASTWOOD DR, SALISBURY, NC 28146-7063
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
AT001791
GA
2255A2300X
Athletic Trainer
ATH.200482
LA
2255A2300X
Athletic Trainer
Primary
LAT-2778
NC
Other
Enumeration date
02/19/2015
Last updated
09/09/2015
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