Healthcare Provider Details

I. General information

NPI: 1871139907
Provider Name (Legal Business Name): JORDYN ASHLYN RINE MS, ATC, CES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MONTICELLO AVE STE B
CHARLOTTESVILLE VA
22902-5698
US

IV. Provider business mailing address

526 GEORGETOWN RD APT C
CHARLOTTESVILLE VA
22901-2435
US

V. Phone/Fax

Practice location:
  • Phone: 434-817-4276
  • Fax:
Mailing address:
  • Phone: 619-481-8153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0126003188
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: