Individual
JESSICA LYNN KUTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
19000 E 191ST STREET, SUITE K, WESTFIELD, IN 46074
(317) 817-1200
Mailing address
2553 ARBOR LAKE LN APT 728, INDIANAPOLIS, IN 46268-4299
(317) 902-2099
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36002359A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200018552
BOARD OF CERTIFICATION NUMBER
—
01
—
36002359A
IN ATHLETIC TRAINING LICENSE
IN
Enumeration date
12/13/2019
Last updated
12/13/2019
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