Individual
GAVIN TYLER TANIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, LAT, ATC
Contact information
Practice address
141 RUSSELL ST, LEWISTON, ME 04240-6024
(207) 786-6255
Mailing address
157 CENTRAL AVE, LEWISTON, ME 04240-5303
(207) 852-3444
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT970
ME
Other
Enumeration date
08/30/2024
Last updated
08/30/2024
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