MEDICARE: MRS. KARI LANGLEY RIDDLE ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	AL897	FL

General Provider Information

NPI Number	:	1720017163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KARI LANGLEY RIDDLE ATC

Provider Business Mailing Address
First Line	:	6060 SW 8TH CT
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33317-3973
Country	:	US
Telephone Number	:	954-214-3089
Fax Number	:	305-348-3673

Provider Business Practice Location Address
First Line	:	8100 SW 10TH ST
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33324-3279
Country	:	US
Telephone Number	:	954-210-1212
Fax Number	:	954-210-1210

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	10/14/2016

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