Healthcare Provider Details

I. General information

NPI: 1154156503
Provider Name (Legal Business Name): CLAUDIA PUTMAN LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1077 COMSTOCK AVE JOHN A LALLY ATHLETICS COMPLEX
SYRACUSE NY
13244-0001
US

IV. Provider business mailing address

109 S WARREN ST APT 803
SYRACUSE NY
13202-5008
US

V. Phone/Fax

Practice location:
  • Phone: 540-231-6410
  • Fax:
Mailing address:
  • Phone: 540-454-9414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number00495101
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: