Provider Demographics
NPI:1104916915
Name:STRICKFADEN, DAVID HAROLD (ATCL)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:HAROLD
Last Name:STRICKFADEN
Suffix:
Gender:M
Credentials:ATCL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3713 LONG BR
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-4572
Mailing Address - Country:US
Mailing Address - Phone:618-656-1044
Mailing Address - Fax:
Practice Address - Street 1:16 GINGER CREEK PKWY
Practice Address - Street 2:
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034-3502
Practice Address - Country:US
Practice Address - Phone:618-656-1122
Practice Address - Fax:618-656-1171
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer