Provider Demographics
NPI:1427325984
Name:WOLLAM, ASHLEY FRANCIS (ATC, LAT)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:FRANCIS
Last Name:WOLLAM
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 S 700 E
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3875
Mailing Address - Country:US
Mailing Address - Phone:253-370-8589
Mailing Address - Fax:
Practice Address - Street 1:3155 S HIDDEN VALLEY DR
Practice Address - Street 2:UNIT #343
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-6671
Practice Address - Country:US
Practice Address - Phone:253-370-8589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6732817-48102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
120602020OtherNATIONAL ATHLETIC TRAINERS' ASSOCIATION BOARD OF CERTIFICATION