Individual
TYLER STEVEN KETTELKAMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
8559 EDINBROOK PKWY, 104, BROOKLYN PARK, MN 55443-3747
(763) 425-5461
Mailing address
1745 CEDAR DR, NEW BRIGHTON, MN 55112-5246
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
04/14/2009
Last updated
04/14/2009
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