Individual
MR. KENNETH ILDEFONSO JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
A.T.R
Contact information
Practice address
1801 MONKS AVE, APARTMENT 413, MANKATO, MN 56001-6356
(203) 584-3347
Mailing address
1801 MONKS AVE, APARTMENT 413, MANKATO, MN 56001-6356
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2474
MN
Other
Enumeration date
01/15/2015
Last updated
01/15/2015
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