MEDICARE: RYNE DAVID MOHRFELD ATC, LAT

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	134331	IA

General Provider Information

NPI Number	:	1770462921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYNE DAVID MOHRFELD ATC, LAT

Provider Business Mailing Address
First Line	:	102 E 4TH AVE
Second Line	:
City	:	LISBON
State	:	IA
Zip	:	52253-9778
Country	:	US
Telephone Number	:	319-440-0375
Fax Number	:

Provider Business Practice Location Address
First Line	:	1330 ELMHURST DR NE
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52402-4797
Country	:	US
Telephone Number	:	319-440-0375
Fax Number	:

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

Provider Enumeration Date	:	09/01/2025
Last Update Date	:	09/01/2025

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