Individual
LISA BASARAB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3451 CHRYSLER DR, JACKSONVILLE, FL 32257-5405
(904) 631-2943
Mailing address
3451 CHRYSLER DR, JACKSONVILLE, FL 32257-5405
(904) 631-2943
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
001809
NY
Other
Enumeration date
01/06/2017
Last updated
01/06/2017
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