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Individual

LASCHONDA MINDEA PITUK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MS, LAT, ATC

Contact information

Practice address
27407 PLANTATION DR NE, ATLANTA, GA 30324-2974
(404) 906-0642
Mailing address
27407 PLANTATION DR NE, ATLANTA, GA 30324-2974

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT00368
GA
390200000X
Student in an Organized Health Care Education/Training Program
PA

Other

Enumeration date
08/29/2018
Last updated
11/17/2020
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