Derek Gustovich

NPI #1689221004 in Mineral Ridge, Ohio

Provider Information

NPI Number: 1689221004
Entity Type: Individual
Name: Derek Gustovich
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Student in an Organized Health Care Education/Training Program
Enumeration Date: Aug 20, 2019
Last Updated: Aug 20, 2019

Practice Location

Address: 1465 MORRIS ST
City: Mineral Ridge
State: Ohio
ZIP Code: 44440-9707
Phone: (330) 766-5630

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist/Technologist - Athletic Trainer — Athletic Trainer	2255A2300X
Student in an Organized Health Care Education/Training Program	390200000X	Primary

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