Individual
ALEXIS ROSE MUTTILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1054 CAMERON CREEK PKWY, TEGA CAY, SC 29708
(803) 579-9474
Mailing address
1054 CAMERON CREEK PKWY, TEGA CAY, SC 29708-0078
(803) 579-9474
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
09/18/2017
Last updated
07/21/2022
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