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General NPI Number Information
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NPI Number | 1184128969
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Entity Type | Individual
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Provider Name | SALLY JANE TROUT ATC
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Gender | Female
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Dates
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Enumeration Date | 03/19/2018
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Last Update Date | 03/19/2018
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Provider Practice Location Address
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Address Line | 725 UNIVERSITY BLVD
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City | DAYTON
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State | OH
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Zip | 45435-0001
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Country | US
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Telephone | 937-245-7551
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Fax |
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Provider Business Mailing Address
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Address Line | 2211 ZINK RD APT 2
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City | BEAVERCREEK
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State | OH
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Zip | 45324-9310
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Country | US
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Telephone | 937-694-8057
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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 |
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License Number State |
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