MEDICARE: JOSHUA PAUL ATC. LAT

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
2	2255A2300X	Athletic Trainer	320097	LA

General Provider Information

NPI Number	:	1982085163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA PAUL ATC. LAT

Provider Business Mailing Address
First Line	:	BOX 92735
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70609-7677
Country	:	US
Telephone Number	:	337-475-5219
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 E MCNEESE ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70609-7677
Country	:	US
Telephone Number	:	337-562-4695
Fax Number	:

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

Provider Enumeration Date	:	06/14/2015
Last Update Date	:	06/14/2023

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