Healthcare Provider Details

I. General information

NPI: 1386594372
Provider Name (Legal Business Name): ALAN PLOSAY
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 PERIMETER DR
MOSCOW ID
83844-9803
US

IV. Provider business mailing address

875 PERIMETER DR
MOSCOW ID
83844-9803
US

V. Phone/Fax

Practice location:
  • Phone: 907-723-6640
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number7381114
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: