Kelly Jo Bagnell, ATC
Specialist/Technologist, Athletic Trainer in Torrance, CA. Individual provider (NPI-1).
NPI number1184188740
StatusActive
Last updated in NPPESMay 21, 2019
Details
- NPI
- 1184188740
- Entity type
- Individual (NPI-1)
- Name
- Kelly Jo Bagnell
- Credential
- ATC
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Jan 29, 2019
- Last updated
- May 21, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2255A2300X | Specialist/Technologist, Athletic Trainer | – | – | Yes |
Practice location
23420 Susana AveTorrance, CA 90505-5430
Phone 310-367-0663
Mailing address
8 Saint Lukes RdAllston, MA 02134-3100
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