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General NPI Number Information
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NPI Number | 1548709082
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Entity Type | Individual
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Provider Name | JOESPH SWEET ATC
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Gender | Male
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Dates
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Enumeration Date | 02/16/2017
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Last Update Date | 02/16/2017
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Provider Practice Location Address
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Address Line | 1 UNIVERSITY PLZ MS 7000
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City | CAPE GIRARDEAU
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State | MO
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Zip | 63701-4710
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Country | US
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Telephone | 616-560-7458
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Fax |
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Provider Business Mailing Address
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Address Line | 1 UNIVERSITY PLAZA MS 7000
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City | CAPE GIRADEAU
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State | MO
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Zip | 63701
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Country | US
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Telephone |
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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 | 2016022756
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License Number State | MO
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