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General NPI Number Information
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NPI Number | 1821554635
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Entity Type | Individual
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Provider Name | JOLIE TANG ATC
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Gender | Female
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Dates
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Enumeration Date | 02/17/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 1 SWAN ST
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City | BATON ROUGE
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State | LA
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Zip | 70813-2260
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Country | US
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Telephone | 225-771-2712
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Fax |
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Provider Business Mailing Address
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Address Line | 116 ELIZABETH AVE
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City | ISELIN
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State | NJ
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Zip | 08830-2260
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Country | US
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Telephone | 732-598-0598
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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 |
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License Number State |
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