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General NPI Number Information
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NPI Number | 1063057198
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Entity Type | Individual
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Provider Name | JOSEPH LAWRENCE CARR LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 11/13/2019
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Last Update Date | 11/13/2019
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Provider Practice Location Address
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Address Line | 808 S TWYCKENHAM DR
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City | SOUTH BEND
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State | IN
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Zip | 46615-1134
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Country | US
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Telephone | 574-283-7700
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Fax |
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Provider Business Mailing Address
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Address Line | 2732 THE ROYAL HUNTSMAN CT
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City | SOUTH BEND
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State | IN
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Zip | 46637-5037
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Country | US
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Telephone | 607-368-4634
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 36003282A
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License Number State | IN
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