Healthcare Provider Details

I. General information

NPI: 1144656695
Provider Name (Legal Business Name): KATHERINE FLETCHER LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2013
Last Update Date: 09/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11011 MONROE RD
MATTHEWS NC
28105-5439
US

IV. Provider business mailing address

12608 ATKINS CIRCLE DR APT 207
CHARLOTTE NC
28277-3794
US

V. Phone/Fax

Practice location:
  • Phone: 704-841-8408
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2293
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: