Martha Dettl-Rivera, EDD, SCAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

2056 Issued in SC

Practice address

1920 Alumni Drive
Rock Hill, SC 29733-0001

Phone

(803) 323-4696

NPI assigned

Jan 24, 2014

Sex

Female

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

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

{
    "created_epoch": "1390521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673913600000",
    "number": "1699198879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "579 STOCKTON WAY",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297326001",
            "telephone_number": "215-264-6090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1920 ALUMNI DRIVE",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297330001",
            "telephone_number": "803-323-4696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETTL-RIVERA",
        "first_name": "MARTHA",
        "name_prefix": "Dr.",
        "credential": "EDD, SCAT, ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-01-24",
        "last_updated": "2023-01-17",
        "certification_date": "2023-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "SC",
            "license": "2056",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in Rock Hill, SC
• Providers in Rock Hill, SC by specialty
• Athletic Trainer in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2023; 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.