Individual
ALISSA NISWONGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LAT, ATC
Contact information
Practice address
3946 ICE WAY, FORT WAYNE, IN 46805-1018
(219) 861-9144
Mailing address
1000 W FOUNTAIN GROVE DR, BRYAN, OH 43506
(419) 636-4536
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
005105
OH
Other
Enumeration date
02/20/2017
Last updated
12/04/2024
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