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General NPI Number Information
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NPI Number | 1114090628
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Entity Type | Individual
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Provider Name | KRISTOPHER KARL HARTZ ATC
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Gender | Male
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 100 N EAST AVE
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City | WAUKESHA
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State | WI
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Zip | 53186-3103
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Country | US
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Telephone | 262-524-7701
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Fax |
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Provider Business Mailing Address
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Address Line | 2218 S MOUND ST
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City | MILWAUKEE
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State | WI
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Zip | 53207-1334
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Country | US
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Telephone | 414-483-0588
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 175-039
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License Number State | WI
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