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General NPI Number Information
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NPI Number | 1114511870
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Entity Type | Individual
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Provider Name | JALEESA IMEARA MACKEY LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 02/23/2021
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Last Update Date | 01/13/2023
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Provider Practice Location Address
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Address Line | 900 ELICKER RD
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City | PITTSBURGH
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State | PA
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Zip | 15239-1098
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Country | US
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Telephone | 412-795-4880
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Fax |
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Provider Business Mailing Address
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Address Line | 360 DEAUVILLE DR APT 10
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City | MONROEVILLE
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State | PA
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Zip | 15146-2913
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Country | US
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Telephone | 707-330-0768
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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 |
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License Number State |
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