Most Relevant Information
Provider Data
| NPI Number: | 1003354242 |
| Provider Name: | MITCH TAFFE M.S., ATC, CSCS |
| Entity Type: | Individual |
| Taxonomy Code: | 2255A2300X |
| Specialty: | Specialist/Technologist |
| License Number: | 36002707A |
Most Important Dates
| Enumeration Date: | 02/08/2017 |
| Last Updated: | 02/08/2017 |
Provider Practice Location
1001 E 17TH ST
ATHLETIC TRAINING
BLOOMINGTON
IN
474081590
Practice Location Phone/Fax
| Phone: | 3203051147 |
| Fax: |
Provider Mailing Location
1212 N GRANT ST APT 6B
BLOOMINGTON
IN
474081824
Provider Mailing Phone/Fax
| Phone: | 3203051147 |
| Fax: |