While, Matthew
While, Matthew is an individual health care provider with primary practice located at 135 N Williamsburg Dr , Bloomington IL 61704-3528. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Athletic Trainer, which is considered as his primary health care specialty. While, Matthew can be contacted via phone (309) 661-8823.Contact Information
Primary practice address
135 N Williamsburg Dr
Bloomington IL 61704-3528
Phone: (309) 661-8823
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Athletic Trainer | 2255A2300X | ||
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Athletic Trainer | 2255A2300X | 096001680 | Illinois |
Profile Details
| NPI number | 1619529666 |
|---|---|
| LBN Legal business name | While, Matthew |
| Credentials | Athletic Trainer, Certified (ATC) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 10th, 2019 |
| Last updated | Jul 10th, 2019 - about 7 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1619529666 | NPPES |
| Illinois | Other | 096001680 | LICENSE |
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