Healthcare Provider Details

I. General information

NPI: 1942183538
Provider Name (Legal Business Name): CORBAN WESTFALL LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2025
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 WASHINGTON AVE
WHEELING WV
26003-6243
US

IV. Provider business mailing address

1159 TOWNSHIP ROAD 162
MINGO JUNCTION OH
43938-7938
US

V. Phone/Fax

Practice location:
  • Phone: 304-243-2000
  • Fax:
Mailing address:
  • Phone: 740-381-7146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT007175
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT001960
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: