NPI 1073508743

James R Beversdorf, LATCSCSPES

Practitioner Athletic Trainer Green Bay, WI

Practice location

Address: 215 N Webster Ave, Green Bay, WI 54301-4813
Phone: (920) 430-4750
Mailing address: 1330 Packerland Dr APT. B-3, Green Bay, WI 54304-1388

Registered specialties

Athletic Trainer Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 2255A2300X Licence 24-039 (WI)

Other Specialist/Technologist providers in Wisconsin →

Registry record

NPI: 1073508743
Entity type: Individual
Sex (as registered): Male
NPI issued: 19 Sep 2005
Record last updated: 8 Jul 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.