Healthcare Provider Details

I. General information

NPI: 1376950014
Provider Name (Legal Business Name): MEGHAN ROBINSON LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 07/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 E GETWELL LOOP
MEMPHIS TN
38152-4210
US

IV. Provider business mailing address

1115 E GETWELL LOOP
MEMPHIS TN
38152-4210
US

V. Phone/Fax

Practice location:
  • Phone: 901-678-3536
  • Fax: 901-678-5622
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1797
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: