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1407210180
MATHEW MCDERMOTT
AZTEC, NM
NPI
1407210180
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: NM 606)
Enumeration Date
2016-04-08
Last Update Date
2016-04-08
Business Address
-- MATHEW MCDERMOTT ATC
500 E CHACO ST
AZTEC, NM 87410-2170
Phone number: 505-334-9414
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Mailing Address
-- MATHEW MCDERMOTT ATC
402 UTE AVE
AZTEC, NM 87410-2232
Phone number: 505-793-0028
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