Individual
RICK DVORAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
2717 18TH ST, SUITE 100, KENOSHA, WI 53140-4666
(262) 551-5650
(866) 245-8064
Mailing address
PO BOX 3497, STURTEVANT, WI 53177-0300
(877) 552-2996
(866) 245-8064
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1818
WI
Other
Enumeration date
05/18/2016
Last updated
05/18/2016
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