MEDICARE: MRS. AMY HOFFNER LAT, ATC, RCEP

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	0619	NC

General Provider Information

NPI Number	:	1558580670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY HOFFNER LAT, ATC, RCEP

Provider Business Mailing Address
First Line	:	3090 GRACE CHURCH RD
Second Line	:
City	:	SALISBURY
State	:	NC
Zip	:	28147-8615
Country	:	US
Telephone Number	:	704-857-3546
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 E MOREHEAD ST
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28202-2610
Country	:	US
Telephone Number	:	704-716-6160
Fax Number	:	704-716-6091

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	07/08/2007

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