Provider Demographics
NPI:1801923107
Name:OSTROW, ALVIN STEWART (ATC)
Entity type:Individual
Prefix:MR
First Name:ALVIN
Middle Name:STEWART
Last Name:OSTROW
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297-1441
Mailing Address - Country:US
Mailing Address - Phone:404-366-4124
Mailing Address - Fax:404-366-0297
Practice Address - Street 1:1075 MAIN ST
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-1441
Practice Address - Country:US
Practice Address - Phone:404-366-4124
Practice Address - Fax:404-366-0297
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0000912255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAAT000091OtherSTATE LICENSE NUMBER