Individual
DYLAN WIEDEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC,LAT
Contact information
Practice address
2024 E CLOVELLY LN, SAINT AUGUSTINE, FL 32092-1093
(904) 495-4485
Mailing address
2024 E CLOVELLY LN, SAINT AUGUSTINE, FL 32092-1093
(904) 495-4485
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AL 3846
FL
Other
Enumeration date
07/13/2014
Last updated
07/13/2014
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