Provider Demographics
NPI:1831717040
Name:RICHTER, ANNA (ATHLETIC TRAINER)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:RICHTER
Suffix:
Gender:F
Credentials:ATHLETIC TRAINER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1946 W JANET CT
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-3757
Mailing Address - Country:US
Mailing Address - Phone:208-869-1161
Mailing Address - Fax:
Practice Address - Street 1:1946 W JANET CT
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-3757
Practice Address - Country:US
Practice Address - Phone:208-869-1161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID0696581389-8Medicaid