DEREK PORT

CAMPBELLSVILLE, KY
NPI1487004636
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: KY  AT512)
Enumeration Date2016-06-20
Last Update Date2016-06-20
Business Address
Mr. DEREK PORT ATC
1 UNIVERSITY DR UPO #823
CAMPBELLSVILLE, KY 42718-2190
Phone number: 270-789-5544
Mailing Address
Mr. DEREK PORT ATC
1 UNIVERSITY DR UPO #823
CAMPBELLSVILLE, KY 42718-2190
Phone number: 270-789-5544
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