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General NPI Number Information
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NPI Number | 1407328933
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Entity Type | Individual
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Provider Name | ERIC AURELIEN LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 12/21/2018
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Last Update Date | 12/21/2018
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Provider Practice Location Address
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Address Line | 31 W COULTER ST
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City | PHILADELPHIA
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State | PA
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Zip | 19144-2801
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Country | US
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Telephone | 215-951-2300
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Fax |
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Provider Business Mailing Address
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Address Line | 100 W OXFORD ST APT 503
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City | PHILADELPHIA
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State | PA
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Zip | 19122-3927
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Country | US
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Telephone | 845-721-4202
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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 | RT006292
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License Number State | PA
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