Gavin Tyler Tanis, MS, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT970 Issued in ME

Practice address

141 Russell St
Lewiston, ME 04240-6024

Phone

(207) 786-6255

NPI assigned

Aug 30, 2024

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1724976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724976000000",
    "number": "1205660263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "157 CENTRAL AVE",
            "city": "LEWISTON",
            "state": "ME",
            "postal_code": "042405303",
            "telephone_number": "207-852-3444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 RUSSELL ST",
            "city": "LEWISTON",
            "state": "ME",
            "postal_code": "042406024",
            "telephone_number": "207-786-6255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANIS",
        "first_name": "GAVIN",
        "middle_name": "TYLER",
        "credential": "MS, LAT, ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-08-30",
        "last_updated": "2024-08-30",
        "certification_date": "2024-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "ME",
            "license": "AT970",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Evelyn Sylvester, LCPS
• Amy Louise Sylvia, OTRL
• Sarah Szczesniak
• Jessica Marie Talbot, CADC
• Sherri Talbot, CADC
• Danielle Lee Tapley, CERTIFIED THERAPEUTI
• Robert P Tardif, DO
• Sara Carrie Tarolli, M.D.
• Tamlyn Marisa Tarzia, MD
• Catharine Gail Taylor, PTA

• Athletic Trainer in Lewiston, ME
• Providers in Lewiston, ME by specialty
• Athletic Trainer in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.