Healthcare Provider Details

I. General information

NPI: 1598441404
Provider Name (Legal Business Name): ANTHONY CARLOS PEREIRA LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 E ARLINGTON BLVD
GREENVILLE NC
27858
US

IV. Provider business mailing address

1301 E ARLINGTON BLVD
GREENVILLE NC
27858
US

V. Phone/Fax

Practice location:
  • Phone: 252-565-8812
  • Fax: 252-565-8814
Mailing address:
  • Phone: 252-565-8812
  • Fax: 252-565-8814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberLAT-4889
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: