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General NPI Number Information
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NPI Number | 1275942989
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Entity Type | Individual
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Provider Name | COURTNEY PALUBICKI LAT
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Gender | Female
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Dates
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Enumeration Date | 08/06/2014
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Last Update Date | 08/12/2014
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Provider Practice Location Address
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Address Line | 907 W. SCHWAGER DRIVE
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City | WHITEWATER
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State | WI
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Zip | 53190
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Country | US
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Telephone | 715-784-4616
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Fax |
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Provider Business Mailing Address
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Address Line | 579 COUNTY Z
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City | PELICAN LAKE
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State | WI
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Zip | 54463-9704
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Country | US
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Telephone | 715-784-4616
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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 | 1504
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License Number State | WI
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