Individual
KONNOR GERALD KINGSMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAT, ATC
Contact information
Practice address
N91W15750 FALLS PKWY, MENOMONEE FALLS, WI 53051-2301
(262) 532-1100
Mailing address
W64N14273 WASHINGTON AVE APT 129, CEDARBURG, WI 53012-3035
(719) 510-5126
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
3219-39
WI
Other
Enumeration date
11/25/2024
Last updated
11/25/2024
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