Healthcare Provider Details

I. General information

NPI: 1013307032
Provider Name (Legal Business Name): STEVEN JAMES WESTLAKE MA, ATC, PTA, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2015
Last Update Date: 01/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2321 COURT ST
REDDING CA
96001-2527
US

IV. Provider business mailing address

2321 COURT ST
REDDING CA
96001-2527
US

V. Phone/Fax

Practice location:
  • Phone: 530-242-8480
  • Fax: 530-242-8485
Mailing address:
  • Phone: 530-242-8480
  • Fax: 530-242-8485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: