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General NPI Number Information
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NPI Number | 1659809861
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Entity Type | Individual
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Provider Name | MR. CHRIS PALMER RENGGLI
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Gender | Male
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Dates
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Enumeration Date | 06/01/2017
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Last Update Date | 06/01/2017
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Provider Practice Location Address
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Address Line | 875 PERIMETER DR
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City | MOSCOW
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State | ID
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Zip | 83844-9803
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Country | US
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Telephone | 888-884-3246
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Fax |
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Provider Business Mailing Address
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Address Line | 6059 SYCAMORE AVE NW
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City | SEATTLE
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State | WA
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Zip | 98107-2042
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Country | US
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Telephone | 206-783-2577
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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 |
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