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NPI Code Detail

MEDICARE: JOSEPH ROSS PARKER ATC, LAT

MEDICARE: JOSEPH ROSS PARKER ATC, LAT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic TrainerATH.J00385LA

General Provider Information

NPI Number : 1073629572
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSEPH ROSS PARKER ATC, LAT
Provider Business Mailing Address
First Line : 2899 SUGARLOAF DR TRLR 198
Second Line :
City : LAKE CHARLES
State : LA
Zip : 70607-7554
Country : US
Telephone Number : 337-824-4547
Fax Number : 337-824-4548
Provider Business Practice Location Address
First Line : 2002 JOHNSON ST
Second Line : SUITE #100
City : JENNINGS
State : LA
Zip : 70546-3646
Country : US
Telephone Number : 337-824-4547
Fax Number : 337-824-4548
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2006
Last Update Date : 07/08/2007

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Directions to “ JOSEPH ROSS PARKER ATC, LAT” Practice Location

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