Individual
ZACK RIESSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.ED., ATC, LAT
Contact information
Practice address
1100 VIRGINIA AVE, COLUMBIA, MO 65212-0001
(573) 884-0339
(573) 882-0569
Mailing address
1100 VIRGINIA AVE, COLUMBIA, MO 65212-0001
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2011026863
MO
Other
Enumeration date
07/01/2014
Last updated
01/10/2017
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