MEDICARE: LAURIE DUEMMLING LAT

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
1	2255A2300X	Athletic Trainer	AL3628	FL

General Provider Information

NPI Number	:	1336557743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURIE DUEMMLING LAT

Provider Business Mailing Address
First Line	:	420 NW 146TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33168-4158
Country	:	US
Telephone Number	:	305-773-9165
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 NW 146TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33168-4158
Country	:	US
Telephone Number	:	305-773-9165
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2014
Last Update Date	:	07/29/2014

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Directions to “ LAURIE DUEMMLING LAT” Practice Location

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