Provider Demographics
NPI:1215765672
Name:RICH, DARIUS TREVON (MAT, LAT, ATC)
Entity type:Individual
Prefix:
First Name:DARIUS
Middle Name:TREVON
Last Name:RICH
Suffix:
Gender:M
Credentials:MAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 W BROADWAY APT 32101
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-7930
Mailing Address - Country:US
Mailing Address - Phone:660-631-7677
Mailing Address - Fax:
Practice Address - Street 1:411 CENTRAL METHODIST SQ STE 1
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:MO
Practice Address - Zip Code:65248-1198
Practice Address - Country:US
Practice Address - Phone:660-248-6251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-25
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20230490112255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer