=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962613505
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTINE MARIE GINTER ATC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1515 UNION AVE
-----------------------------------------------------
City | MOBERLY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65270-9407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 660-269-3189
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9436 HIGHWAY BB
-----------------------------------------------------
City | HUNTSVILLE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65259-2706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 660-269-9838
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number | 111933
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------