Individual
ASHLEY ROSE LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
1901 RANDOLPH RD, SPORTS MEDICINE, CHARLOTTE, NC 28207-1101
(336) 716-8467
Mailing address
1901 RANDOLPH RD, SPORTS MEDICINE, CHARLOTTE, NC 28207
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1758
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1758
NORTH CAROLINA BOARD OF ATHLETIC TRAINER EXAMINERS LICENSE NUMBER
NC
01
—
2000004245
BOARD OF CERITIFICATION, INC. CERTIFICATION NUMBER
—
Enumeration date
03/22/2012
Last updated
02/05/2014
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