Individual
ZANE T WILDERMUTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1001 W PIKE ST, JACKSON CENTER, OH 45334-6066
(937) 596-6111
Mailing address
1001 W PIKE ST, JACKSON CENTER, OH 45334-6066
(937) 596-6111
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
003902
OH
Other
Enumeration date
10/23/2017
Last updated
08/22/2022
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