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NPI Code Detail

MEDICARE: KARLA MARIE HALDE ATC, LAT

MEDICARE: KARLA MARIE HALDE 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
12255A2300XAthletic Trainer096.004582IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1U77716965OTHERCIGNA HEALTH

General Provider Information

NPI Number : 1902482730
Entity Type Code : Individual
Provider Name (Legal Business Name) : KARLA MARIE HALDE ATC, LAT
Provider Business Mailing Address
First Line : 6908 LOYET RD
Second Line :
City : COLLINSVILLE
State : IL
Zip : 62234-6520
Country : US
Telephone Number : 618-974-8489
Fax Number :
Provider Business Practice Location Address
First Line : 4500 MEMORIAL DR
Second Line :
City : BELLEVILLE
State : IL
Zip : 62226-5399
Country : US
Telephone Number : 618-233-7750
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2021
Last Update Date : 03/22/2021

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