Healthcare Provider Details

I. General information

NPI: 1508527672
Provider Name (Legal Business Name): ELIZABETH PATE MAYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH DANIELLE PATE

II. Dates (important events)

Enumeration Date: 12/31/2021
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 BLUE LAKE DR
VESTAVIA AL
35243-1907
US

IV. Provider business mailing address

PO BOX 2808
FORT RILEY KS
66442-0808
US

V. Phone/Fax

Practice location:
  • Phone: 205-602-8114
  • Fax:
Mailing address:
  • Phone: 205-602-8114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: