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Individual

ERIKA KIETZMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LAT, ATC

Contact information

Practice address
2406 E EMPIRE ST, BLOOMINGTON, IL 61704-3630
(309) 663-9300
Mailing address
102 N ORR DR APT 2, NORMAL, IL 61761-1945
(217) 899-4139

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096.005666
IL

Other

Enumeration date
05/29/2023
Last updated
05/29/2023
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