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General NPI Number Information
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NPI Number | 1679053789
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Entity Type | Individual
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Provider Name | DAVID REDINGER LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 08/17/2018
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Last Update Date | 08/06/2020
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Provider Practice Location Address
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Address Line | 3409 N WHISTLER LN APT 201
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City | BOISE
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State | ID
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Zip | 83703-6298
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Country | US
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Telephone | 509-961-7341
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Fax |
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Provider Business Mailing Address
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Address Line | 4493 N FIFESHIRE WAY
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City | BOISE
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State | ID
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Zip | 83713-9559
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Country | US
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Telephone | 509-961-7341
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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 | AT-755
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License Number State | ID
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