Healthcare Provider Details

I. General information

NPI: 1528704178
Provider Name (Legal Business Name): ALL VERTICAL TRAINING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2022
Last Update Date: 05/06/2022
Certification Date: 04/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MARIETTA ST.
ALTANTA GA
30377
US

IV. Provider business mailing address

PO BOX 94722
ATLANTA GA
30377-1722
US

V. Phone/Fax

Practice location:
  • Phone: 585-314-5828
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. AARON VICKERS
Title or Position: FOUNDER/PRACTITIONER
Credential: CPT, SPS, FA
Phone: 585-314-5828