Healthcare Provider Details

I. General information

NPI: 1215527817
Provider Name (Legal Business Name): ANNIKA PEIGHTON GARCIA LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2021
Last Update Date: 01/17/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 JACK BRANCH DR
BOONE NC
28607
US

IV. Provider business mailing address

186 VILLAGE DR
BOONE NC
28607-7925
US

V. Phone/Fax

Practice location:
  • Phone: 828-262-2000
  • Fax:
Mailing address:
  • Phone: 520-484-4516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberLAT-5232
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: