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General NPI Number Information
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NPI Number | 1932088978
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Entity Type | Individual
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Provider Name | CHAYTIN LEA
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Gender | Male
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Dates
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Enumeration Date | 09/02/2025
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 1 UNIVERSITY PLZ
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City | CAPE GIRARDEAU
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State | MO
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Zip | 63701-4710
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Country | US
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Telephone | 314-805-0491
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Fax |
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Provider Business Mailing Address
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Address Line | 12524 TALL PINE DR
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City | STE GENEVIEVE
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State | MO
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Zip | 63670-8617
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Country | US
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Telephone | 314-805-0491
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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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