Healthcare Provider Details

I. General information

NPI: 1619783602
Provider Name (Legal Business Name): CHRISTOPHER MOHR MBA, ATC, LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 W 22ND ST
SIOUX FALLS SD
57105-1699
US

IV. Provider business mailing address

6800 S LOUISE AVE
SIOUX FALLS SD
57108-6026
US

V. Phone/Fax

Practice location:
  • Phone: 605-331-5000
  • Fax:
Mailing address:
  • Phone: 605-322-3278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateSD

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: