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General NPI Number Information
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NPI Number | 1760106165
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Entity Type | Organization
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Legal Business Name | HOLD FAST PERFORMANCE & WELLNESS
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Dates
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Enumeration Date | 09/28/2022
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Last Update Date | 09/28/2022
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Provider Practice Location Address
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Address Line | 13000 ECKEL JUNCTION RD
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City | PERRYSBURG
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State | OH
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Zip | 43551-1311
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Country | US
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Telephone | 419-482-8244
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Fax |
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Provider Business Mailing Address
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Address Line | 7224 HUNTERS CHASE
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City | MAUMEE
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State | OH
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Zip | 43537-9250
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Country | US
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Telephone | 952-240-1853
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Fax |
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Authorized Official
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Title or Position | LICENSED ATHLETIC TRAINER
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Name | COURTNEY DESORBO
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Credential | MS, AT, ATC, CSCS
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Telephone | 419-482-8244
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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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