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NPI Code Detail

MEDICARE: MARK DAVID RIEGER ATC

MEDICARE: MARK DAVID RIEGER 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
12255A2300XAthletic TrainerIL

General Provider Information

NPI Number : 1720056385
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK DAVID RIEGER ATC
Provider Business Mailing Address
First Line : 1104 MAPLE TREE LN
Second Line :
City : MAHOMET
State : IL
Zip : 61853-3537
Country : US
Telephone Number : 217-586-3772
Fax Number :
Provider Business Practice Location Address
First Line : 810 W ANTHONY DR
Second Line :
City : URBANA
State : IL
Zip : 61802-7431
Country : US
Telephone Number : 217-383-6992
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2006
Last Update Date : 07/08/2007

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