Individual
MR. TIMOTHY D MIESMER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
421 N WOODLAND BLVD UNIT 8317, DELAND, FL 32723-8418
(859) 248-5467
Mailing address
6048 LAUREN LN, RICHMOND, KY 40475-6702
(859) 248-5467
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
AT1210
KY
2255A2300X
Athletic Trainer
Primary
AL5565
FL
Other
Enumeration date
02/20/2008
Last updated
03/18/2020
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