Individual
DALTEN TYLER SIMNITCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
4100 LAKE DR SE STE 300, GRAND RAPIDS, MI 49546-8292
(616) 267-8860
Mailing address
3941 BRENTON CT SE, GRAND RAPIDS, MI 49508-8948
(989) 415-2957
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2601002567
MI
Other
Enumeration date
01/24/2019
Last updated
02/02/2024
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