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General NPI Number Information
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NPI Number | 1811354046
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Entity Type | Individual
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Provider Name | CESILEY RIDEAU ATC
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Gender | Female
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Dates
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Enumeration Date | 01/19/2016
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Last Update Date | 01/19/2016
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Provider Practice Location Address
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Address Line | 1306 N EL PASO AVE HULL 128
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-8814
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Country | US
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Telephone | 479-968-0642
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Fax | 479-498-6044
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Provider Business Mailing Address
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Address Line | 1306 N EL PASO AVE HULL 128
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-8814
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Country | US
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Telephone | 479-968-0642
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Fax | 479-498-6044
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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 | 698
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License Number State | AR
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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 | 694
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License Number State | OK
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