Individual
ELIZABETH LEANN AUGUSTINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
1500 PROVIDENT DR STE C, WARSAW, IN 46580-3297
(574) 372-7671
Mailing address
2802 HUFFMAN ST, WINONA LAKE, IN 46590-2065
(574) 377-0560
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36001368A
IN
Other
Enumeration date
06/15/2012
Last updated
06/15/2012
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