Healthcare Provider Details

I. General information

NPI: 1366841157
Provider Name (Legal Business Name): EMILY WOOD LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2014
Last Update Date: 08/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 GREEN MOR CT APT 1
SALISBURY MD
21804-6206
US

IV. Provider business mailing address

5664 CLARK RD
CONESUS NY
14435-9592
US

V. Phone/Fax

Practice location:
  • Phone: 585-245-4265
  • Fax:
Mailing address:
  • Phone: 585-245-4265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberA0000526
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: