Provider Demographics
NPI:1760543995
Name:RISINGER, STEVEN D (ATC LAT)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:D
Last Name:RISINGER
Suffix:
Gender:M
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 1:3416 WHITE RIVER CT.
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46012
Mailing Address - Country:US
Mailing Address - Phone:765-621-9963
Mailing Address - Fax:765-641-3841
Practice Address - Street 1:1526 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46012-3111
Practice Address - Country:US
Practice Address - Phone:765-641-4491
Practice Address - Fax:765-641-3841
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36000001A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN22Other2255A2300X ATHLETIC TRAIN