Healthcare Provider Details

I. General information

NPI: 1144690058
Provider Name (Legal Business Name): ALEXANDRA WOLD ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2015
Last Update Date: 07/05/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6130 KENNEDY AVE
CINCINNATI OH
45213-1806
US

IV. Provider business mailing address

6130 KENNEDY AVE
CINCINNATI OH
45213-1806
US

V. Phone/Fax

Practice location:
  • Phone: 847-217-9559
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT002490
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT005217
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: