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1730785296
BRANDON TYLER RIEDEL
PORTLAND, OR
NPI
1730785296
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: IL 2000032988)
Enumeration Date
2020-12-09
Last Update Date
2020-12-09
Business Address
BRANDON TYLER RIEDEL ATC
2219 SE 68TH AVE
PORTLAND, OR 97215-4026
Phone number: 503-517-1063
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Mailing Address
BRANDON TYLER RIEDEL ATC
1007 S COLLEGE ST
NEWBERG, OR 97132-3366
Phone number: 815-579-9454
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