Individual
MR. JUSTIN LAQUAN CULP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
420 W MAIN ST, DANVILLE, VA 24541-3612
(704) 606-4063
Mailing address
3910 COCHRAN RD SW, CONCORD, NC 28027-8710
(704) 606-4063
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
30980192
NC
390200000X
Student in an Organized Health Care Education/Training Program
30980192
NC
Other
Enumeration date
08/03/2017
Last updated
08/03/2017
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