Healthcare Provider Details

I. General information

NPI: 1932875747
Provider Name (Legal Business Name): ALLISON WEATHERFORD ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALLISON NOGGLE ATC

II. Dates (important events)

Enumeration Date: 08/20/2021
Last Update Date: 08/20/2021
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4627 MOUNT ALIFAN DR
SAN DIEGO CA
92111-2505
US

IV. Provider business mailing address

4627 MOUNT ALIFAN DR
SAN DIEGO CA
92111-2505
US

V. Phone/Fax

Practice location:
  • Phone: 619-520-9186
  • Fax:
Mailing address:
  • Phone: 619-520-9186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: