Individual
JALYN GORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
#1 ASPEN DRIVE, FORT DEFIANCE, AZ 86504
(928) 729-2290
Mailing address
PO BOX 864, WINDOW ROCK, AZ 86515-0864
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
ATR-009263
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/14/2018
Last updated
11/30/2020
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