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General NPI Number Information
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NPI Number | 1518260827
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Entity Type | Individual
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Provider Name | ARTHUR JOHN GABRIEL LAT
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Gender | Male
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Dates
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Enumeration Date | 12/08/2010
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Last Update Date | 12/08/2010
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Provider Practice Location Address
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Address Line | 138 N LUCRETIA ST JOHNSON CENTER
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City | OAKLAND CITY
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State | IN
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Zip | 47660-1038
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Country | US
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Telephone | 812-746-1262
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Fax | 812-746-1262
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Provider Business Mailing Address
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Address Line | 138 N. LUCRETIA STREET JOHNSON CENTER
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City | OAKLAND CITY
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State | IN
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Zip | 47660
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Country | US
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Telephone | 812-746-1262
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Fax | 812-746-1262
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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 | 36001651A
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License Number State | IN
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