Individual
KENNETH LASSITER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, ATC, LAT
Contact information
Practice address
1200 MURCHISON RD, FAYETTEVILLE, NC 28301-4252
(336) 953-0668
Mailing address
6528 TAMPICO CT, FAYETTEVILLE, NC 28303-2334
(336) 953-0668
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
20000190028
NC
Other
Enumeration date
10/01/2020
Last updated
12/23/2021
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