Healthcare Provider Details

I. General information

NPI: 1356807184
Provider Name (Legal Business Name): NIA ALEXA NEZ LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2019
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 BRIGHTON BLVD APT 408
DENVER CO
80216-3695
US

IV. Provider business mailing address

147 E 730 N
SANTAQUIN UT
84655-8277
US

V. Phone/Fax

Practice location:
  • Phone: 801-793-6727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT.0002559
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: