Cody Ahlgrimm, LAT, ATC
Individual provider Active NPI Athletic Trainer · Corsicana, TX
NPI 1922564533 · NPPES record last updated May 5, 2020
Key facts
- NPI
- 1922564533
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- AT8056 (TX)
- Practice address
- 3200 W 7TH Ave
Corsicana, TX 75110-4899 - Phone
- (719) 510-9762
- NPI assigned
- Feb 19, 2019
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT8056 | TX | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AT8056 | TX | Yes |
Addresses
Primary practice location
3200 W 7TH Ave
Corsicana, TX 75110-4899
Mailing address
704 N 14TH St
Corsicana, TX 75110-3844
Other providers in Corsicana, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 5, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.