Individual
KYLE T EBERSOLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD, ATC, LAT
Contact information
Practice address
DEPT OF KINES & COM HLTH, FREER HALL 209, MC-052, UNIVERSITY OF ILLINOIS, URBANA, IL 61801
(217) 333-9517
Mailing address
2005 VALE ST, CHAMPAIGN, IL 61822-3592
(217) 417-0653
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
IL
Other
Enumeration date
03/15/2007
Last updated
07/08/2007
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