Reginald Mungrue
Specialist/Technologist, Athletic Trainer in Lakeland, FL. Individual provider (NPI-1).
NPI number1962018077
StatusActive
Last updated in NPPESSep 23, 2020
Details
- NPI
- 1962018077
- Entity type
- Individual (NPI-1)
- Name
- Reginald Mungrue
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Sep 23, 2020
- Certification date
- Sep 23, 2020
- Last updated
- Sep 23, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2255A2300X | Specialist/Technologist, Athletic Trainer | al3036 | FL | Yes |
Practice location
111 Lake Hollingsworth DrLakeland, FL 33801-5698
Phone 863-680-4267
Mailing address
7357 Gunstock DrLakeland, FL 33809-6616
Phone 863-712-0261 · Fax 863-680-4122
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