Individual
BRYAN JOSEPH DOMITRZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
501 N PARKSIDE RD, NORMAL, IL 61761-2780
(309) 557-4402
Mailing address
W792 POTTERS CIR, EAST TROY, WI 53120-2317
(414) 828-4911
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096.004969
IL
Other
Enumeration date
02/16/2021
Last updated
02/16/2021
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