NPI 1164879300

Rick Dvorak, ATCLAT

Practitioner Athletic Trainer Kenosha, WI

Practice location

Address: 2717 18th St Suite 100, Kenosha, WI 53140-4666
Phone: (262) 551-5650
Fax: (866) 245-8064
Mailing address: PO Box 3497, Sturtevant, WI 53177-0300

Registered specialties

Athletic Trainer Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 2255A2300X Licence 1818 (WI)

Other Specialist/Technologist providers in Wisconsin →

Registry record

NPI: 1164879300
Entity type: Individual
Sex (as registered): Male
NPI issued: 18 May 2016
Record last updated: 18 May 2016

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.