Individual
MATTHEW WHILE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
135 N WILLIAMSBURG DR, BLOOMINGTON, IL 61704-3528
(309) 661-8823
Mailing address
PO BOX 5387, BLOOMINGTON, IL 61702-5387
(309) 661-8823
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096001680
IL
2255A2300X
Athletic Trainer
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
096001680
LICENSE
IL
Enumeration date
07/10/2019
Last updated
07/10/2019
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