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General NPI Number Information
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NPI Number | 1407821242
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Entity Type | Individual
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Provider Name | TRESA LYNN ALTON ATC
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Gender | Female
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Dates
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Enumeration Date | 02/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2345 MAIN STREET
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City | GLASTONBURY
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State | CT
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Zip | 06033
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Country | US
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Telephone | 502-452-3605
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Fax | 502-452-0484
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Provider Business Mailing Address
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Address Line | 129 SALT RIVER DR
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City | SHEPHERDSVILLE
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State | KY
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Zip | 40165-6152
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Country | US
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Telephone | 502-452-3605
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Fax | 502-452-0484
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT238
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License Number State | KY
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