Provider Demographics
NPI:1225360035
Name:ALLRED, DAVID REID (MS, ATC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:REID
Last Name:ALLRED
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2528 WOODSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:HAILEY
Mailing Address - State:ID
Mailing Address - Zip Code:83333-5004
Mailing Address - Country:US
Mailing Address - Phone:208-578-5020
Mailing Address - Fax:208-578-5120
Practice Address - Street 1:1250 FOX ACRES RD
Practice Address - Street 2:
Practice Address - City:HAILEY
Practice Address - State:ID
Practice Address - Zip Code:83333-8824
Practice Address - Country:US
Practice Address - Phone:208-578-5020
Practice Address - Fax:208-578-5120
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAT-3492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer