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General NPI Number Information
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NPI Number | 1104461573
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Entity Type | Individual
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Provider Name | JOSHUA MASNER LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 11/08/2019
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Last Update Date | 08/25/2020
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Provider Practice Location Address
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Address Line | 7149 S PUTNAM COUNTY RD
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City | COATESVILLE
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State | IN
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Zip | 46121-9065
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Country | US
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Telephone | 317-437-4732
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Fax |
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Provider Business Mailing Address
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Address Line | 1651 S DOBSON RD APT 255
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City | MESA
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State | AZ
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Zip | 85202-5639
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Country | US
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Telephone | 317-437-4732
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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 | ATR-009239
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License Number State | AZ
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