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General NPI Number Information
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NPI Number | 1174065569
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Entity Type | Individual
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Provider Name | LAUREN TEODOROVICI LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 11/16/2016
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Last Update Date | 11/16/2016
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Provider Practice Location Address
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Address Line | 340 SIGNAL HILL DR
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City | STATESVILLE
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State | NC
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Zip | 28625-4483
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Country | US
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Telephone | 704-239-9281
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Fax | 704-978-3205
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Provider Business Mailing Address
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Address Line | 3115 DUNNS MOUNTAIN RD
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City | SALISBURY
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State | NC
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Zip | 28146-8045
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Country | US
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Telephone | 701-239-9281
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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