Provider Demographics
NPI:1891880993
Name:AHONEN, SEAN BRADLEY (ATC)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:BRADLEY
Last Name:AHONEN
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 1:1300 COGSWELL AVE
Mailing Address - Street 2:
Mailing Address - City:PELL CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35125-1299
Mailing Address - Country:US
Mailing Address - Phone:804-921-6766
Mailing Address - Fax:
Practice Address - Street 1:1300 COGSWELL AVE
Practice Address - Street 2:
Practice Address - City:PELL CITY
Practice Address - State:AL
Practice Address - Zip Code:35125-1299
Practice Address - Country:US
Practice Address - Phone:804-921-6766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
AL28422255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer