NPI 1164435657

Raymond Jerome Stadt, ATC

Practitioner Athletic Trainer Blue Island, IL

Practice location

Address: 12700 Sacramento Ave, Blue Island, IL 60406-1822
Phone: (708) 597-6300
Fax: (708) 597-6386
Mailing address: 20032 S Mallory Dr, Frankfort, IL 60423-9279

Registered specialties

Athletic Trainer Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 2255A2300X

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Registry record

NPI: 1164435657
Entity type: Individual
Sex (as registered): Male
NPI issued: 14 Aug 2006
Record last updated: 8 Jul 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.