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General NPI Number Information
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NPI Number | 1144923574
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Entity Type | Individual
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Provider Name | ALONZO EDWARD RANGE JR. MBA,ATS
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Gender | Male
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Dates
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Enumeration Date | 03/24/2023
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Last Update Date | 03/24/2023
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Provider Practice Location Address
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Address Line | 4100 S 4TH ST
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City | LEAVENWORTH
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State | KS
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Zip | 66048-5082
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Country | US
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Telephone | 800-752-7043
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Fax |
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Provider Business Mailing Address
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Address Line | 518 OAK ST
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City | JUNCTION CITY
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State | KS
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Zip | 66441-3843
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Country | US
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Telephone | 785-209-8636
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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 |
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License Number State | KS
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