Individual
KAYLA DAWN RUSTERHOLTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., A.T.C.
Contact information
Practice address
4682 LAKE VALLEY DR APT 2B, LISLE, IL 60532-1449
(972) 978-1854
Mailing address
4682 LAKE VALLEY DR APT 2B, LISLE, IL 60532-1449
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096.003240
IL
Other
Enumeration date
04/19/2014
Last updated
04/19/2014
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