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General NPI Number Information
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NPI Number | 1831902196
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Entity Type | Individual
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Provider Name | ALICIA MANN ATC
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Gender | Female
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Dates
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Enumeration Date | 01/30/2025
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 1919 E THOMAS RD
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City | PHOENIX
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State | AZ
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Zip | 85016-7710
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Country | US
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Telephone | 602-933-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 5912 SHERMAN AVE
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City | DOWNERS GROVE
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State | IL
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Zip | 60516-1766
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Country | US
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Telephone | 630-974-0045
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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 | 009379
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License Number State | AZ
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