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1649488503
MIYA VENETIA SULLIVAN
SAINT LOUIS, MO
NPI
1649488503
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: MO 2000170998)
Enumeration Date
2007-05-21
Last Update Date
2007-07-08
Business Address
Ms. MIYA VENETIA SULLIVAN MS, ATC
3672 W PINE MALL BLVD ATHLETICS
SAINT LOUIS, MO 63108-3304
Phone number: 314-977-7024
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Mailing Address
Ms. MIYA VENETIA SULLIVAN MS, ATC
19 SOMERSET TERRACE CT
SAINT LOUIS, MO 63136-2406
Phone number: 314-521-5084
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