Provider Demographics
NPI:1356773964
Name:ATHERHOLT, ALLISON SACHIKO (PA-C, ATC)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:SACHIKO
Last Name:ATHERHOLT
Suffix:
Gender:F
Credentials:PA-C, ATC
Other - Prefix:MS
Other - First Name:ALLISON
Other - Middle Name:SACHIKO
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:8890 N UNION BLVD STE 171
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-2701
Mailing Address - Country:US
Mailing Address - Phone:719-364-5633
Mailing Address - Fax:719-364-5639
Practice Address - Street 1:5818 N NEVADA AVENUE
Practice Address - Street 2:SUITE 110
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-2701
Practice Address - Country:US
Practice Address - Phone:719-365-1950
Practice Address - Fax:719-364-5639
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056296363AM0700X
COPA.0005138363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical