Keith William Miessau, ATC, LAT
Specialist/Technologist, Athletic Trainer in Lake Mary, FL. Individual provider (NPI-1).
NPI number1750357869
StatusActive
Last updated in NPPESApr 29, 2008
Details
- NPI
- 1750357869
- Entity type
- Individual (NPI-1)
- Name
- Keith William Miessau
- Credential
- ATC, LAT
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Feb 28, 2006
- Last updated
- Apr 29, 2008
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2255A2300X | Specialist/Technologist, Athletic Trainer | AL 1930 | FL | Yes |
Practice location
655 Longwood Lake Mary RdLake Mary, FL 32746-3701
Phone 407-320-9753
Mailing address
1575 Hunters Stand RunOviedo, FL 32765-5100
Phone 407-619-0951
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