Individual
KYLA ANN LICHTENWALNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
2422 FOX RIVER PKWY UNIT I, WAUKESHA, WI 53189-5803
(262) 501-6384
Mailing address
3300 E PARKSIDE BLVD, APPLETON, WI 54915-5632
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
WI
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
10/06/2017
Last updated
07/07/2020
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