Alexander L Avallon Jr., ATC
Individual provider Active NPI Athletic Trainer · Fort Washington, PA
NPI 1962546804 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1962546804
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- RT001279A (PA)
- Practice address
- 414 Commerce Dr
Suite 130 Temple Sports Medicine
Fort Washington, PA 19034-2618 - Phone
- (215) 641-0700
- Fax
- (215) 641-0637
- NPI assigned
- Feb 16, 2007
- 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 |
|---|---|---|---|
| RT001279A | PA | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | RT001279A | PA | Yes |
Addresses
Primary practice location
414 Commerce Dr
Suite 130 Temple Sports Medicine
Fort Washington, PA 19034-2618
Mailing address
414 Commerce Dr
Suite 130 Temple Sports Medicine
Fort Washington, PA 19034-2618
Phone (215) 641-0700
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 22 | Other | PA | RESPIRATORY, REHABILITATI |
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- Timothy Michael Asztalos
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- Saida Azimbegova
- David J Badolato
- Baek Dental Group
- Thomas J Balshi
All providers in Fort Washington, PA · Athletic Trainer in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.