Provider Demographics
NPI:1285989632
Name:APPALACHIAN STATE UNIVERSITY
Entity type:Organization
Organization Name:APPALACHIAN STATE UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ATHLETIC TRAINING SERV
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:H
Authorized Official - Last Name:ROBEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LAT, ATC, PRT
Authorized Official - Phone:828-262-6265
Mailing Address - Street 1:OWENS FIELD HOUSE
Mailing Address - Street 2:135 JACK BRANCH DR
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28608-0001
Mailing Address - Country:US
Mailing Address - Phone:828-262-6265
Mailing Address - Fax:828-262-7099
Practice Address - Street 1:OWENS FIELD HOUSE
Practice Address - Street 2:135 JACK BRANCH DR
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28608-0001
Practice Address - Country:US
Practice Address - Phone:828-262-6265
Practice Address - Fax:828-262-7099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy