Healthcare Provider Details

I. General information

NPI: 1326671975
Provider Name (Legal Business Name): CAROLINE SILBERGLITT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2020
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WASHINGTON STATE UNIVERSITY
PULLMAN WA
99163
US

IV. Provider business mailing address

2132 REDROCK PL
MARTINEZ CA
94553-5058
US

V. Phone/Fax

Practice location:
  • Phone: 509-335-3564
  • Fax:
Mailing address:
  • Phone: 925-330-3959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

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: