| NPI | 1457561698 |
|---|---|
| Former Name | JESSICA RAQUEL DYSART |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: GA AT001878) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AL 927) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2011-07-11 |