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NPI Code Detail

MEDICARE: LYDIA DUGGAN LAT, ATC

MEDICARE: LYDIA DUGGAN LAT, 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 Trainer10250916OR
22255A2300XAthletic TrainerA161584259WA

General Provider Information

NPI Number : 1568270395
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYDIA DUGGAN LAT, ATC
Provider Business Mailing Address
First Line : 1311 VINE ST
Second Line :
City : CINCINNATI
State : OH
Zip : 45202-7118
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1311 VINE ST
Second Line :
City : CINCINNATI
State : OH
Zip : 45202-7118
Country : US
Telephone Number : 859-817-7500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/26/2024
Last Update Date : 12/26/2024

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Directions to “ LYDIA DUGGAN LAT, ATC” Practice Location

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