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General NPI Number Information
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NPI Number | 1992192124
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Entity Type | Individual
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Provider Name | PAUL ANTHONY LERNER A.T.C.
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Gender | Male
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Dates
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Enumeration Date | 04/26/2015
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Last Update Date | 04/26/2015
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Provider Practice Location Address
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Address Line | 405 CAMBERLEY WAY APT F
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City | CHESAPEAKE
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State | VA
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Zip | 23320-4971
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Country | US
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Telephone | 757-630-6421
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Fax |
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Provider Business Mailing Address
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Address Line | 637 KINGSBOROUGH SQ STE F
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City | CHESAPEAKE
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State | VA
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Zip | 23320-4944
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Country | US
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Telephone | 757-547-7554
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Fax | 757-548-0647
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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 | 0126000345
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License Number State | VA
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