Provider Demographics
NPI:1154068054
Name:RIVAL YOUTH SPORTS & TRAINING
Entity Type:Organization
Organization Name:RIVAL YOUTH SPORTS & TRAINING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/DELEGATE
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHANEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:SONNIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-982-0337
Mailing Address - Street 1:17340 E DORADO DR
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80015-3030
Mailing Address - Country:US
Mailing Address - Phone:720-982-0337
Mailing Address - Fax:
Practice Address - Street 1:17340 E DORADO DR
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80015-3030
Practice Address - Country:US
Practice Address - Phone:720-982-0337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-13
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation TherapistGroup - Multi-Specialty
No405300000XOther Service ProvidersPrevention ProfessionalGroup - Multi-Specialty