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NPI Code Detail

MEDICARE: LITHANY DEVONTENNO MS, LAT, ATC

MEDICARE: LITHANY DEVONTENNO MS, 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
12255A2300XAthletic Trainer

General Provider Information

NPI Number : 1912462730
Entity Type Code : Individual
Provider Name (Legal Business Name) : LITHANY DEVONTENNO MS, LAT, ATC
Provider Business Mailing Address
First Line : 4710 N 5TH ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85012-1738
Country : US
Telephone Number : 505-410-6848
Fax Number :
Provider Business Practice Location Address
First Line : 4710 N 5TH ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85012-1738
Country : US
Telephone Number : 505-410-6848
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2019
Last Update Date : 12/16/2024

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