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General NPI Number Information
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NPI Number | 1073644589
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Entity Type | Individual
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Provider Name | MICHELLE MARIE LESPERANCE LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 07/29/2019
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Provider Practice Location Address
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Address Line | 5401 BROADLEAF RD
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City | SUMMERFIELD
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State | NC
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Zip | 27358-7825
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Country | US
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Telephone | 336-404-8419
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Fax |
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Provider Business Mailing Address
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Address Line | 3301 N BROOK DR
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City | GREENSBORO
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State | NC
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Zip | 27410-8368
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Country | US
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Telephone | 336-272-7192
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Fax | 336-217-7237
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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 | 0554
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number | 322419423
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License Number State | NC
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