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General NPI Number Information
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NPI Number | 1831865237
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Entity Type | Organization
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Legal Business Name | DAWG MENTALITY SPORTS PERFORMANCE LLC
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Dates
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Enumeration Date | 08/17/2021
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Last Update Date | 08/17/2021
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Provider Practice Location Address
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Address Line | 829 GOLDEN HORSESHOE LN
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City | SANFORD
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State | NC
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Zip | 27330-7311
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Country | US
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Telephone | 919-698-7479
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Fax |
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Provider Business Mailing Address
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Address Line | 829 GOLDEN HORSESHOE LN
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City | SANFORD
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State | NC
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Zip | 27330-7311
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Country | US
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Telephone | 919-698-7479
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE MANAGER
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Name | MR. ISRAEL WILLIAMS
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Credential | CSCS
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Telephone | 919-698-7479
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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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