Healthcare Provider Details

I. General information

NPI: 1396158184
Provider Name (Legal Business Name): RORY DIRK EYRING ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 06/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2108 HORTON ST
FORT SCOTT KS
66701-3141
US

IV. Provider business mailing address

802 E 21ST ST
FORT SCOTT KS
66701-2986
US

V. Phone/Fax

Practice location:
  • Phone: 620-223-2700
  • Fax: 620-223-4438
Mailing address:
  • Phone: 620-223-2700
  • Fax: 620-223-4438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number24-00810
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: