Healthcare Provider Details

I. General information

NPI: 1699638825
Provider Name (Legal Business Name): JASMINE ESPINOZA MAT, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 ROGERS ST
COLUMBIA MO
65216-0001
US

IV. Provider business mailing address

2817 N WILLOWBROOK RD APT B
COLUMBIA MO
65202-2510
US

V. Phone/Fax

Practice location:
  • Phone: 573-875-7411
  • Fax:
Mailing address:
  • Phone: 479-431-8535
  • Fax: 479-431-8535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2025032242
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: