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MR. ERIC MICHAEL STREETER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MS, ATC

Contact information

Practice address
2040 S NEIL ST, CHAMPAIGN, IL 61820-7220
(217) 352-3330
Mailing address
2204 E TRAILSIDE DR N, MAHOMET, IL 61853-8512
(217) 622-7175

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096-001764
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
096-001764
LICENSED ATHLETIC TRAINER
IL
Enumeration date
09/20/2005
Last updated
04/16/2015
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