Individual
MITCH TAFFE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S., ATC, CSCS
Contact information
Practice address
1001 E 17TH ST, ATHLETIC TRAINING, BLOOMINGTON, IN 47408-1590
(320) 305-1147
Mailing address
1212 N GRANT ST APT 6B, BLOOMINGTON, IN 47408-1824
(320) 305-1147
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36002707A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
YRP053M85918
BLUECROSS BLUESHIELD
IN
Enumeration date
02/08/2017
Last updated
02/08/2017
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