Provider Demographics
NPI:1932875747
Name:WEATHERFORD, ALLISON (ATC)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:WEATHERFORD
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:NOGGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:4627 MOUNT ALIFAN DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-2505
Mailing Address - Country:US
Mailing Address - Phone:619-520-9186
Mailing Address - Fax:
Practice Address - Street 1:4627 MOUNT ALIFAN DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-2505
Practice Address - Country:US
Practice Address - Phone:619-520-9186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer