Individual
MR. JEREK CHARLES PONTIUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
627 N GREENFIELD DR, FREEPORT, IL 61032-2914
(815) 990-5395
Mailing address
627 N GREENFIELD DR, FREEPORT, IL 61032-2914
(815) 990-5395
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1924
WI
Other
Enumeration date
01/11/2018
Last updated
01/11/2018
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