Healthcare Provider Details

I. General information

NPI: 1457468746
Provider Name (Legal Business Name): JOSEPH M FRIEDRICH JR. ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 RIO RANCHO BLVD SE # 210
RIO RANCHO NM
87124-1006
US

IV. Provider business mailing address

1380 RIO RANCHO BLVD SE # 210
RIO RANCHO NM
87124-1006
US

V. Phone/Fax

Practice location:
  • Phone: 609-703-5792
  • Fax:
Mailing address:
  • Phone: 609-703-5792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT-2024-0009
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number25MR00127900
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT003916
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: