Healthcare Provider Details

I. General information

NPI: 1669892501
Provider Name (Legal Business Name): GENA RINARD MS, AT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2014
Last Update Date: 04/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 TURWILL LN
KALAMAZOO MI
49006-4231
US

IV. Provider business mailing address

315 TURWILL LN
KALAMAZOO MI
49006-4231
US

V. Phone/Fax

Practice location:
  • Phone: 269-343-8170
  • Fax:
Mailing address:
  • Phone: 269-343-8170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2601001112
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: