Individual
TYLER J HIETPAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
624 W MCKINLEY AVE, LITTLE CHUTE, WI 54140-1525
(920) 213-9402
Mailing address
624 W MCKINLEY AVE, LITTLE CHUTE, WI 54140-1525
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
02/10/2025
Last updated
02/10/2025
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