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Individual
CASEY WIECK
Active
Individual
CASEY WIECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC, LMT
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT.003604
OH
225700000X
Massage Therapist
33.014715-T-Z
OH
Other
Enumeration date
04/23/2014
Last updated
04/23/2014
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