MEDICARE: AI AI LA

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	390200000X	Student in an Organized Health Care Education/Training Program
2	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1437778255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AI AI LA

Provider Business Mailing Address
First Line	:	6406 W PARIS ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-5009
Country	:	US
Telephone Number	:	813-385-6055
Fax Number	:

Provider Business Practice Location Address
First Line	:	6406 W PARIS ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-5009
Country	:	US
Telephone Number	:	813-385-6055
Fax Number	:

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

Provider Enumeration Date	:	04/12/2020
Last Update Date	:	09/24/2021

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Directions to “ AI AI LA ” Practice Location

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