Healthcare Provider Details

I. General information

NPI: 1942943519
Provider Name (Legal Business Name): RICHARD BIEDIGER ATC, LAT, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 KAGE RD
CAPE GIRARDEAU MO
63701-2173
US

IV. Provider business mailing address

2920 KAGE RD
CAPE GIRARDEAU MO
63701-2173
US

V. Phone/Fax

Practice location:
  • Phone: 512-801-4347
  • Fax:
Mailing address:
  • Phone: 512-801-4347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2020032361
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: