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General NPI Number Information
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NPI Number | 1134651458
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Entity Type | Individual
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Provider Name | STEPHANIE RYCHLEC MAT, ATC, OTC
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Gender | Female
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Dates
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Enumeration Date | 03/28/2017
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Last Update Date | 12/18/2018
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Provider Practice Location Address
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Address Line | 4110 BRIARGATE PKWY STE 145
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-7836
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Country | US
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Telephone | 719-622-4550
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Fax |
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Provider Business Mailing Address
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Address Line | 6450 BLACK RIDGE VW APT 205
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City | COLORADO SPRINGS
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State | CO
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Zip | 80924-4455
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Country | US
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Telephone | 303-906-8069
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT5911
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT.0001808
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License Number State | CO
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