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General NPI Number Information
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NPI Number | 1699170969
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Entity Type | Individual
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Provider Name | JORDAN RICKS ATC
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Gender | Male
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Dates
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Enumeration Date | 10/29/2014
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Last Update Date | 07/08/2015
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Provider Practice Location Address
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Address Line | 51 W COLLEGE ST
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City | WAYNESBURG
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State | PA
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Zip | 15370-1258
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Country | US
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Telephone | 330-301-1496
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Fax |
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Provider Business Mailing Address
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Address Line | 150 GARWOOD DR
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City | CANFIELD
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State | OH
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Zip | 44406-1123
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Country | US
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Telephone |
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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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