Most Relevant Information
Provider Data
| NPI Number: | 1003203068 |
| Provider Name: | JACQUELINE DURST ATC, LAT |
| Entity Type: | Individual |
| Taxonomy Code: | 207PS0010X |
| Specialty: | Emergency Medicine |
| License Number: | A00192 |
Most Important Dates
| Enumeration Date: | 04/16/2015 |
| Last Updated: | 04/16/2015 |
Provider Practice Location
101 BRADDOCK RD
FROSTBURG STATE UNIVERSITY KINESIOLOGY DEPARTMENT
FROSTBURG
MD
215322303
Practice Location Phone/Fax
| Phone: | 3016972801 |
| Fax: |
Provider Mailing Location
27 FROST AVE
FROSTBURG
MD
215321623
Provider Mailing Phone/Fax
| Phone: | 3016972801 |
| Fax: |