NPI 1104969336

Russell Donald de Lap, ATC

Practitioner Athletic Trainer Mequon, WI

Practice location

Address: 12800 N Lake Shore Dr, Mequon, WI 53097-2418
Phone: (262) 243-4323
Fax: (262) 243-2969
Mailing address: 1165 Tower Hill Dr, Brookfield, WI 53045-6705

Registered specialties

Athletic Trainer Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 2255A2300X Licence 4039 (WI)

Other Specialist/Technologist providers in Wisconsin →

Registry record

NPI: 1104969336
Entity type: Individual
Sex (as registered): Male
NPI issued: 15 Feb 2007
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.