Provider Demographics
NPI:1083023568
Name:ALVARADO, ANNA (ATC)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:ALVARADO
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:DUTTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:1505 HOWARD DR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN INN
Mailing Address - State:SC
Mailing Address - Zip Code:29644-9404
Mailing Address - Country:US
Mailing Address - Phone:517-930-2386
Mailing Address - Fax:
Practice Address - Street 1:200 PATEWOOD DRIVE BUILDING B SUITE 170
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615
Practice Address - Country:US
Practice Address - Phone:864-454-8340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer