Provider Demographics
NPI:1902265937
Name:RICHTER, TRISTAN (ATC)
Entity Type:Individual
Prefix:
First Name:TRISTAN
Middle Name:
Last Name:RICHTER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E LONGLEAF DR
Mailing Address - Street 2:APT 1218
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36832-1102
Mailing Address - Country:US
Mailing Address - Phone:973-356-1695
Mailing Address - Fax:
Practice Address - Street 1:301 WIRE RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36849-5419
Practice Address - Country:US
Practice Address - Phone:334-844-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT002768390200000X
AL1807390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program