Individual
KESTRA RIZZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
1 ROBERT EGLY DR, ROSSVILLE, IN 46065-9664
(925) 708-7829
Mailing address
1 ROBERT EGLY DR, ROSSVILLE, IN 46065-9664
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36003503A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000041072
BOARD OF CERTIFICATION FOR THE ATHLETIC TRAINER
—
01
—
36003503A
INDIANA ATHLETIC TRAINING LICENSURE
IN
Enumeration date
01/14/2019
Last updated
12/02/2021
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