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General NPI Number Information
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NPI Number | 1699719542
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Entity Type | Individual
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Provider Name | JEFFREY WAYNE MARSEE LAT, ATC, DHED
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Gender | Male
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 09/17/2019
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Provider Practice Location Address
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Address Line | 236 W READE AVE HEALTH AND EXERCISE SCIENCE
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City | UPLAND
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State | IN
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Zip | 46989-1001
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Country | US
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Telephone | 765-998-5132
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Fax |
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Provider Business Mailing Address
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Address Line | 658 W HARSAX DR
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City | UPLAND
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State | IN
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Zip | 46989-9008
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Country | US
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Telephone | 765-998-2728
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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 | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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