Gavin Tyler Tanis, MS, LAT, ATC
Specialist/Technologist, Athletic Trainer in Lewiston, ME. Individual provider (NPI-1).
NPI number1205660263
StatusActive
Last updated in NPPESAug 30, 2024
Details
- NPI
- 1205660263
- Entity type
- Individual (NPI-1)
- Name
- Gavin Tyler Tanis
- Credential
- MS, LAT, ATC
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Aug 30, 2024
- Certification date
- Aug 30, 2024
- Last updated
- Aug 30, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2255A2300X | Specialist/Technologist, Athletic Trainer | AT970 | ME | Yes |
Practice location
141 Russell StLewiston, ME 04240-6024
Phone 207-786-6255
Mailing address
157 Central AveLewiston, ME 04240-5303
Phone 207-852-3444
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All 13 Athletic Trainer providers in Lewiston · All 2,175 providers in Lewiston
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