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General NPI Number Information
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NPI Number | 1053664185
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Entity Type | Individual
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Provider Name | JENNIFER LYN WALTRIP MS, AT
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Gender | Female
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Dates
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Enumeration Date | 10/26/2012
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Last Update Date | 10/26/2012
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Provider Practice Location Address
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Address Line | 7402 W CATALINA DR TREVOR BROWNE HIGH SCHOOL
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City | PHOENIX
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State | AZ
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Zip | 85033-5502
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Country | US
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Telephone | 602-764-8636
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Fax |
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Provider Business Mailing Address
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Address Line | 2088 S. 216TH LANE
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City | BUCKEYE
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State | AZ
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Zip | 85326
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Country | US
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Telephone | 602-319-1147
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0110
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License Number State | AZ
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