Provider Demographics
NPI:1780047027
Name:TRUMPOLD, NICOLE ELIZABETH (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ELIZABETH
Last Name:TRUMPOLD
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 1:650 COLTON CIR NE
Mailing Address - Street 2:UNIT 11
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-6760
Mailing Address - Country:US
Mailing Address - Phone:319-361-3490
Mailing Address - Fax:
Practice Address - Street 1:1220 1ST AVE NE
Practice Address - Street 2:EBY FIELDHOUSE
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5008
Practice Address - Country:US
Practice Address - Phone:319-361-3490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0009472255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer