Individual
MR. NICHOLAS RAY TJEERDSMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
3946 ICE WAY, FORT WAYNE, IN 46808-1735
(319) 939-7102
Mailing address
3946 ICE WAY, FORT WAYNE, IN 46808
(319) 939-7102
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
07/15/2013
Last updated
01/05/2018
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