Individual
ERIC M. PROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAT
Contact information
Practice address
9601 TOWNLINE RD, MINOCQUA, WI 54548-9099
(715) 358-1000
Mailing address
1000 N OAK AVE, MARSHFIELD, WI 54449-5703
(715) 387-5511
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1218
WI
Other
Enumeration date
11/23/2010
Last updated
08/22/2013
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