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General NPI Number Information
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NPI Number | 1851823561
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Entity Type | Individual
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Provider Name | JENNA LEE DROMGOOLE MS, LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 03/31/2017
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Last Update Date | 02/22/2023
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Provider Practice Location Address
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Address Line | 6100 MAIN ST
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City | HOUSTON
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State | TX
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Zip | 77005-1827
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Country | US
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Telephone | 973-747-2378
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Fax |
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Provider Business Mailing Address
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Address Line | 178 CENTRAL AVE
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City | WEST CALDWELL
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State | NJ
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Zip | 07006-7747
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT9064
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License Number State | TX
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