Healthcare Provider Details

I. General information

NPI: 1568275998
Provider Name (Legal Business Name): GABRIEL FLEER ATC, LAT, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3545 S NATIONAL AVE
SPRINGFIELD MO
65807-7310
US

IV. Provider business mailing address

5703 N FARM ROAD 117
WILLARD MO
65781-7222
US

V. Phone/Fax

Practice location:
  • Phone: 417-818-9149
  • Fax:
Mailing address:
  • Phone: 417-818-9149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2001021516
License Number StateMO

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: