Individual
NICHOLAS JOHN LEGRAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
1111 N GLENSTONE AVE, SPRINGFIELD, MO 65802-2125
(573) 579-8968
Mailing address
4355 S NATIONAL AVE APT 712, SPRINGFIELD, MO 65810-2653
(573) 579-8968
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2018026636
MO
Other
Enumeration date
09/06/2018
Last updated
09/06/2018
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