=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235486010
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAULA N NEAL LAT, ATC, CSCS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2012
-----------------------------------------------------
Last Update Date | 11/07/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10501 FGCU BLVD S
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33965-6502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-745-4299
-----------------------------------------------------
Fax | 239-590-7398
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10501 FGCU BLVD S
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33965-6502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-745-4299
-----------------------------------------------------
Fax | 239-590-7398
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number | 0211
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------