Individual
BRANDON TYLER RIEDEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
2219 SE 68TH AVE, PORTLAND, OR 97215-4026
(503) 517-1063
Mailing address
1007 S COLLEGE ST, NEWBERG, OR 97132-3366
(815) 579-9454
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000032988
IL
Other
Enumeration date
12/09/2020
Last updated
12/09/2020
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