Provider Demographics
NPI:1699233072
Name:MURRAY, RYLIE M (ATC)
Entity type:Individual
Prefix:MISS
First Name:RYLIE
Middle Name:M
Last Name:MURRAY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 TIMBERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-6862
Mailing Address - Country:US
Mailing Address - Phone:618-444-9074
Mailing Address - Fax:
Practice Address - Street 1:1047 CENTURY DR
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-3772
Practice Address - Country:US
Practice Address - Phone:618-307-3434
Practice Address - Fax:618-307-3435
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2255A2300X
MO20210353152255A2300X
IL0960053842255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer