BRYAN JOSEPH DOMITRZ

NORMAL, IL
NPI1871186304
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: IL  096.004969)
Enumeration Date2021-02-16
Last Update Date2021-02-16
Business Address
BRYAN JOSEPH DOMITRZ ATC, LAT
501 N PARKSIDE RD
NORMAL, IL 61761-2780
Phone number: 309-557-4402
Mailing Address
BRYAN JOSEPH DOMITRZ ATC, LAT
W792 POTTERS CIR
EAST TROY, WI 53120-2317
Phone number: 414-828-4911
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