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General NPI Number Information
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NPI Number | 1508901349
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Entity Type | Individual
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Provider Name | JAMIE LYNNE LAVIS ATC, PES, EMT
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Gender | Female
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 413 MARKET ST APT 1
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City | BROWNSVILLE
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State | PA
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Zip | 15417-1774
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Country | US
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Telephone | 814-244-9049
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Fax |
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Provider Business Mailing Address
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Address Line | 1841 EUGENE ST
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City | JOHNSTOWN
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State | PA
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Zip | 15904-1009
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Country | US
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Telephone | 814-254-4726
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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 | RT004098
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License Number State | PA
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