Healthcare Provider Details

I. General information

NPI: 1992192124
Provider Name (Legal Business Name): PAUL ANTHONY LERNER A.T.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2015
Last Update Date: 04/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 CAMBERLEY WAY APT F
CHESAPEAKE VA
23320-4971
US

IV. Provider business mailing address

637 KINGSBOROUGH SQ STE F
CHESAPEAKE VA
23320-4944
US

V. Phone/Fax

Practice location:
  • Phone: 757-630-6421
  • Fax:
Mailing address:
  • Phone: 757-547-7554
  • Fax: 757-548-0647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0126000345
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: