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General NPI Number Information
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NPI Number | 1992769392
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Entity Type | Individual
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Provider Name | GERALD EDWARD RISHEL A.T.,C.
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Gender | Male
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Dates
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Enumeration Date | 04/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2614 E MARKET ST
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City | WARREN
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State | OH
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Zip | 44483-6204
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Country | US
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Telephone | 330-394-8282
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Fax | 330-394-6931
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Provider Business Mailing Address
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Address Line | 1404 DIFFORD DR
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City | NILES
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State | OH
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Zip | 44446-2843
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Country | US
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Telephone | 330-652-5209
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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 | AT000130
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License Number State | OH
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