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General NPI Number Information
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NPI Number | 1265450803
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Entity Type | Individual
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Provider Name | AMY KULCZYCKI ATC, CSCS
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Gender | Female
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 200 S SHELDON ST
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City | RANTOUL
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State | IL
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Zip | 61866-2431
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Country | US
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Telephone | 217-892-2151
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Fax |
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Provider Business Mailing Address
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Address Line | 1176 POMONA DR
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City | CHAMPAIGN
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State | IL
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Zip | 61822-1857
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Country | US
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Telephone | 217-390-4877
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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 |
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License Number State |
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