Healthcare Provider Details

I. General information

NPI: 1326547712
Provider Name (Legal Business Name): MARIE-JOSEE BERTRAND LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 02/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4553 PIERRE DE-COUBERTIN
MONTREAL QC
H1V3N7
CA

IV. Provider business mailing address

4553 PIERRE DE-COUBERTIN
MONTREAL QC
137
CA

V. Phone/Fax

Practice location:
  • Phone: 514-259-4553
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number36000215A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: