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General NPI Number Information
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NPI Number | 1922586742
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Entity Type | Individual
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Provider Name | ELENA ST. ONGE LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 08/02/2018
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Last Update Date | 05/01/2020
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Provider Practice Location Address
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Address Line | 9101 PINEVILLE MATTHEWS RD STE D
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City | PINEVILLE
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State | NC
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Zip | 28134-8826
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Country | US
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Telephone | 734-487-9957
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Fax |
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Provider Business Mailing Address
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Address Line | 7910 BRADENTON DR
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City | CHARLOTTE
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State | NC
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Zip | 28210-7218
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Country | US
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Telephone |
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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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