MEDICARE: GINA MARIE LINN 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	RT005042	PA

General Provider Information

NPI Number	:	1811264013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA MARIE LINN LAT, ATC

Provider Business Mailing Address
First Line	:	137 COLUMBIA DR
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15236-4428
Country	:	US
Telephone Number	:	412-759-0341
Fax Number	:

Provider Business Practice Location Address
First Line	:	3381 ROUTE 130
Second Line	:
City	:	HARRISON CITY
State	:	PA
Zip	:	15636-1238
Country	:	US
Telephone Number	:	724-744-0580
Fax Number	:

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

Provider Enumeration Date	:	11/16/2011
Last Update Date	:	03/03/2014

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