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General NPI Number Information
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NPI Number | 1730404906
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Entity Type | Individual
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Provider Name | JUSTIN DEER ATC
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Gender | Male
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Dates
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Enumeration Date | 03/31/2010
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Last Update Date | 03/31/2010
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Provider Practice Location Address
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Address Line | 350 N ARIZONA AVE
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City | CHANDLER
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State | AZ
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Zip | 85225-4578
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Country | US
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Telephone | 480-812-7700
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Fax |
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Provider Business Mailing Address
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Address Line | 2456 S NIELSON ST
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City | GILBERT
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State | AZ
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Zip | 85295-7139
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Country | US
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Telephone | 480-656-9936
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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 | 0093
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License Number State | AZ
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