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NPI Code Detail

MEDICARE: MRS. CHRISTINA AUGUSTA ELDRIDGE ATC, CSCS

MEDICARE: MRS. CHRISTINA AUGUSTA ELDRIDGE ATC, CSCS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic TrainerIL

General Provider Information

NPI Number : 1417925355
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CHRISTINA AUGUSTA ELDRIDGE ATC, CSCS
Provider Business Mailing Address
First Line : 203 SYCAMORE LN
Second Line :
City : MACHESNEY PARK
State : IL
Zip : 61115-2846
Country : US
Telephone Number : 815-877-1277
Fax Number : 815-395-4585
Provider Business Practice Location Address
First Line : 5510 E STATE ST
Second Line :
City : ROCKFORD
State : IL
Zip : 61108-2381
Country : US
Telephone Number : 815-395-4585
Fax Number : 815-395-4507
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2006
Last Update Date : 07/08/2007

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