MEDICARE: LAUREN REES 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	RT005640	PA

General Provider Information

NPI Number	:	1639500176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN REES LAT, ATC

Provider Business Mailing Address
First Line	:	75 EVELYN DR
Second Line	:
City	:	MILLERSBURG
State	:	PA
Zip	:	17061-1258
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10330 U.S. 209
Second Line	:
City	:	TOWER CITY
State	:	PA
Zip	:	17980-9474
Country	:	US
Telephone Number	:	717-647-2167
Fax Number	:

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

Provider Enumeration Date	:	12/10/2013
Last Update Date	:	12/10/2013

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