Individual
KRISTOFER VANDER WILT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
B.S., ATC, LAT
Contact information
Practice address
1500 GREENLAND DR, MURFREESBORO, TN 37132-3100
(850) 499-1913
Mailing address
1500 GREENLAND DR, MURFREESBORO, TN 37132-3100
(850) 499-1913
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1936
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1936
TENNESSEE STATE LICENSE NUMBER
TN
Enumeration date
11/23/2015
Last updated
11/23/2015
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