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General NPI Number Information
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NPI Number | 1790318673
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Entity Type | Individual
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Provider Name | GRETEL ANN BRIAND LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 02/19/2020
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Last Update Date | 02/19/2020
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Provider Practice Location Address
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Address Line | 15800 NW 42ND AVE
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City | MIAMI GARDENS
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State | FL
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Zip | 33054-6155
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Country | US
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Telephone | 305-626-3690
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Fax |
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Provider Business Mailing Address
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Address Line | 8670 SW 32ND ST
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City | MIAMI
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State | FL
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Zip | 33155-2330
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Country | US
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Telephone | 785-318-1043
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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 | AL4366
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License Number State | FL
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