Individual
HENRY BENJAMIN WILANTEWICZ IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
201 SHIELDS BLDG, UNIVERSITY PARK, PA 16802-1204
(814) 865-5471
Mailing address
213 ASHBURN AVE, MANAHAWKIN, NJ 08050-2378
(609) 276-4081
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
12/04/2023
Last updated
12/04/2023
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