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General NPI Number Information
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NPI Number | 1447809710
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Entity Type | Individual
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Provider Name | GINA LIN MCDONALD LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 09/09/2019
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Last Update Date | 09/09/2019
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Provider Practice Location Address
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Address Line | 3551 HIGHLAND AVE
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-2100
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Country | US
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Telephone | 630-275-2640
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Fax |
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Provider Business Mailing Address
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Address Line | 13132 W CREEKSIDE DR
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City | HOMER GLEN
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State | IL
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Zip | 60491-8105
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Country | US
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Telephone | 708-822-4462
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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 | 096003062
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License Number State | IL
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