Cullen Fridley, ATC, LAT, CIDN

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

ATR-100152 Issued in AZ

Practice address

2240 Winrow Rd
Sierra Vista, AZ 85613-5080

Phone

(850) 384-8511

NPI assigned

Mar 28, 2019

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1553731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729382400000",
    "number": "1073074407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2240 WINROW RD",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856135080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2240 WINROW RD",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856135080",
            "telephone_number": "850-384-8511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRIDLEY",
        "first_name": "CULLEN",
        "credential": "ATC, LAT, CIDN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-28",
        "last_updated": "2024-10-20",
        "certification_date": "2024-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "AZ",
            "license": "ATR-100152",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in Sierra Vista, AZ
• Providers in Sierra Vista, AZ by specialty
• Athletic Trainer in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.