Healthcare Provider Details

I. General information

NPI: 1962240200
Provider Name (Legal Business Name): ALISON COLLEEN HAUGHEY MAT, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2024
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 DAUPHIN ST
MOBILE AL
36608-1780
US

IV. Provider business mailing address

864 WILLOW BRIDGE DR W
MOBILE AL
36695-4560
US

V. Phone/Fax

Practice location:
  • Phone: 251-380-3493
  • Fax:
Mailing address:
  • Phone: 972-977-0018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number3637
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: