Individual
JACOB RADLICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
1 BILLS DR, ORCHARD PARK, NY 14127-2237
(716) 939-4469
Mailing address
34 BRIARCLIFF RD, BUFFALO, NY 14225-1502
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
003379
NY
Other
Enumeration date
04/06/2017
Last updated
04/06/2017
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