Provider Demographics
NPI:1962546804
Name:AVALLON, ALEXANDER L JR (ATC)
Entity type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:L
Last Name:AVALLON
Suffix:JR
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:414 COMMERCE DR
Mailing Address - Street 2:SUITE 130 TEMPLE SPORTS MEDICINE
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-2618
Mailing Address - Country:US
Mailing Address - Phone:215-641-0700
Mailing Address - Fax:215-641-0637
Practice Address - Street 1:414 COMMERCE DR
Practice Address - Street 2:SUITE 130 TEMPLE SPORTS MEDICINE
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-2618
Practice Address - Country:US
Practice Address - Phone:215-641-0700
Practice Address - Fax:215-641-0637
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART001279A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA22OtherRESPIRATORY, REHABILITATI