Provider Demographics
NPI:1942183538
Name:WESTFALL, CORBAN (LAT, ATC)
Entity type:Individual
Prefix:
First Name:CORBAN
Middle Name:
Last Name:WESTFALL
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1159 TOWNSHIP ROAD 162
Mailing Address - Street 2:
Mailing Address - City:MINGO JUNCTION
Mailing Address - State:OH
Mailing Address - Zip Code:43938-7938
Mailing Address - Country:US
Mailing Address - Phone:740-381-7146
Mailing Address - Fax:
Practice Address - Street 1:316 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6243
Practice Address - Country:US
Practice Address - Phone:304-243-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-30
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0071752255A2300X
WVAT0019602255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer