MEDICARE: LEE ANN HEWITT LAT, ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer		CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003339128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEE ANN HEWITT LAT, ATC

Provider Business Mailing Address
First Line	:	417 CHASTAIN CIR
Second Line	:
City	:	RICHMOND HILL
State	:	GA
Zip	:	31324-9386
Country	:	US
Telephone Number	:	720-937-8014
Fax Number	:

Provider Business Practice Location Address
First Line	:	5000 CROWN BLVD
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80239-4378
Country	:	US
Telephone Number	:	720-937-8014
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2017
Last Update Date	:	11/04/2021

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