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General NPI Number Information
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NPI Number | 1639620537
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Entity Type | Individual
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Provider Name | DENISE ALDER ATC
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Gender | Female
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Dates
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Enumeration Date | 10/17/2016
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Last Update Date | 10/17/2016
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Provider Practice Location Address
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Address Line | 365 RIPLEY ISLAND RD
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City | AFTON
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State | TN
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Zip | 37616-5860
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Country | US
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Telephone | 630-815-9646
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Fax |
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Provider Business Mailing Address
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Address Line | 1185 W MOUNTAIN VIEW RD APT 3319
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City | JOHNSON CITY
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State | TN
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Zip | 37604-2523
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Country | US
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Telephone |
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Fax |
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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 | 1916
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License Number State | TN
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