Provider Demographics
NPI:1801012331
Name:LAI, TINA N (ATC)
Entity Type:Individual
Prefix:MISS
First Name:TINA
Middle Name:N
Last Name:LAI
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:909 30TH ST S
Mailing Address - Street 2:APT 18
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1160
Mailing Address - Country:US
Mailing Address - Phone:770-365-2198
Mailing Address - Fax:205-581-7155
Practice Address - Street 1:806 SAINT VINCENTS DR
Practice Address - Street 2:WCC, STE 415
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1684
Practice Address - Country:US
Practice Address - Phone:205-939-3000
Practice Address - Fax:205-581-7155
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer