Provider Demographics
NPI:1508365230
Name:EWIGMAN, ALYSON (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:
Last Name:EWIGMAN
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 KESSLER PL TRLR 2
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1395
Mailing Address - Country:US
Mailing Address - Phone:660-734-4622
Mailing Address - Fax:
Practice Address - Street 1:195 ACADEMIC-ATHLETIC CENTER
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351
Practice Address - Country:US
Practice Address - Phone:606-783-2392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer