Provider Demographics
NPI:1710125455
Name:RADEL, SAMANTHA LUCILLE (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LUCILLE
Last Name:RADEL
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WARTBURG BLVD
Mailing Address - Street 2:DEPARTMENT OF ATHLETICS-WARTBURG COLLEGE
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-2215
Mailing Address - Country:US
Mailing Address - Phone:319-352-8725
Mailing Address - Fax:319-352-8528
Practice Address - Street 1:100 WARTBURG BLVD
Practice Address - Street 2:DEPARTMENT OF ATHLETICS-WARTBURG COLLEGE
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-2215
Practice Address - Country:US
Practice Address - Phone:319-352-8725
Practice Address - Fax:319-352-8528
Is Sole Proprietor?:No
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0006412255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer