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NPI Code Detail

MEDICARE: KAITLIN LIORA REGAN ATC

MEDICARE: KAITLIN LIORA REGAN ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic TrainerRT006803PA

General Provider Information

NPI Number : 1316464985
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAITLIN LIORA REGAN ATC
Provider Business Mailing Address
First Line : 109 UNIVERSITY SQ
Second Line :
City : ERIE
State : PA
Zip : 16541-0002
Country : US
Telephone Number : 607-759-1054
Fax Number :
Provider Business Practice Location Address
First Line : 109 UNIVERSITY SQ
Second Line :
City : ERIE
State : PA
Zip : 16541-0002
Country : US
Telephone Number : 607-759-1054
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2017
Last Update Date : 08/24/2017

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Directions to “ KAITLIN LIORA REGAN ATC” Practice Location

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