Healthcare Provider Details

I. General information

NPI: 1083121198
Provider Name (Legal Business Name): CRAIG ALLEN COATS ATC/L, CA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2018
Last Update Date: 01/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 E CACTUS RD
PHOENIX AZ
85032-7042
US

IV. Provider business mailing address

14096 W BANFF LN
SURPRISE AZ
85379-8608
US

V. Phone/Fax

Practice location:
  • Phone: 602-919-0486
  • Fax:
Mailing address:
  • Phone: 480-734-6995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0496
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: