Provider Demographics
NPI:1063830057
Name:ABERNATHY, ALYSHA (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:ALYSHA
Middle Name:
Last Name:ABERNATHY
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:564 LAKELAND PLZ
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2783
Mailing Address - Country:US
Mailing Address - Phone:770-781-9050
Mailing Address - Fax:
Practice Address - Street 1:564 LAKELAND PLZ
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2783
Practice Address - Country:US
Practice Address - Phone:770-781-9050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0022562255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer