Individual
JAMES FREDERICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5635 TAYLOR AVE, MOUNT PLEASANT, WI 53403-9732
(262) 930-7616
Mailing address
5635 TAYLOR AVE, MOUNT PLEASANT, WI 53403-9732
(262) 930-7616
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
F6364559441101
WI
390200000X
Student in an Organized Health Care Education/Training Program
F6364559441101
WI
Other
Enumeration date
02/10/2017
Last updated
07/02/2020
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