NPI 1205660263

Gavin Tyler Tanis, MSLATATC

Practitioner Athletic Trainer Lewiston, ME

Practice location

Address: 141 Russell St, Lewiston, ME 04240-6024
Phone: (207) 786-6255
Mailing address: 157 Central Ave, Lewiston, ME 04240-5303

Registered specialties

Athletic Trainer Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 2255A2300X Licence AT970 (ME)

Other Specialist/Technologist providers in Maine →

Registry record

NPI: 1205660263
Entity type: Individual
Sex (as registered): Male
NPI issued: 30 Aug 2024
Record last updated: 30 Aug 2024

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.