Healthcare Provider Details

I. General information

NPI: 1801360037
Provider Name (Legal Business Name): ALLISON MARY CONLEY LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2019
Last Update Date: 01/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 STATE ST
MOUNT PLEASANT PA
15666-1060
US

IV. Provider business mailing address

143 S SPRING AVE
GREENSBURG PA
15601-2831
US

V. Phone/Fax

Practice location:
  • Phone: 724-474-1005
  • Fax: 724-547-0472
Mailing address:
  • Phone: 724-961-9601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRTO000240
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: