Healthcare Provider Details

I. General information

NPI: 1447927942
Provider Name (Legal Business Name): HALEY MICHAEL THORPE ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6126 73RD PL E
COTTONDALE AL
35453-1409
US

IV. Provider business mailing address

6126 73RD PL E
COTTONDALE AL
35453-1409
US

V. Phone/Fax

Practice location:
  • Phone: 205-657-7142
  • Fax:
Mailing address:
  • Phone: 205-657-7142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2627
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: