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General NPI Number Information
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NPI Number | 1790907186
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Entity Type | Individual
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Provider Name | GAYLE LEE CONNER A.T.,C.
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Gender | Male
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 301NORTH KING STREET SHEPHERD UNIVERSITY
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City | SHEPHERDSTOWN
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State | WV
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Zip | 25443
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Country | US
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Telephone | 304-876-5348
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Fax | 304-876-3267
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Provider Business Mailing Address
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Address Line | 920 S RALEIGH ST
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City | MARTINSBURG
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State | WV
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Zip | 25401-3119
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Country | US
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Telephone | 304-876-5348
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Fax | 304-876-3267
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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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