MEDICARE: MR. JEAN BAPTISTE LAPORTE ATC, PT

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

General Provider Information

NPI Number	:	1538583299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEAN BAPTISTE LAPORTE ATC, PT

Provider Business Mailing Address
First Line	:	800 S MINT ST
Second Line	:	CAROLINA PANTHERS
City	:	CHARLOTTE
State	:	NC
Zip	:	28202-1518
Country	:	US
Telephone Number	:	704-358-7563
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 S MINT ST
Second Line	:	CAROLINA PANTHERS
City	:	CHARLOTTE
State	:	NC
Zip	:	28202-1518
Country	:	US
Telephone Number	:	704-358-7563
Fax Number	:

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

Provider Enumeration Date	:	02/14/2014
Last Update Date	:	02/14/2014

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