Individual
TANNER SHULTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
27W157 WALNUT DR, WINFIELD, IL 60190-2051
(630) 390-8417
Mailing address
27W157 WALNUT DR, WINFIELD, IL 60190-2051
(630) 390-8417
Taxonomy
Speciality
Code
Description
License number
State
224Y00000X
Clinical Exercise Physiologist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
26-1393224
—
IL
Enumeration date
09/10/2018
Last updated
09/10/2018
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