Healthcare Provider Details

I. General information

NPI: 1770462921
Provider Name (Legal Business Name): RYNE DAVID MOHRFELD ATC, LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2025
Last Update Date: 09/01/2025
Certification Date: 09/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 ELMHURST DR NE
CEDAR RAPIDS IA
52402-4797
US

IV. Provider business mailing address

102 E 4TH AVE
LISBON IA
52253-9778
US

V. Phone/Fax

Practice location:
  • Phone: 319-440-0375
  • Fax:
Mailing address:
  • Phone: 319-440-0375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number134331
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: