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NPI Code Detail

MEDICARE: KARTISIA ESCO ATC, LAT

MEDICARE: KARTISIA ESCO 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.200170LA

General Provider Information

NPI Number : 1568747640
Entity Type Code : Individual
Provider Name (Legal Business Name) : KARTISIA ESCO ATC, LAT
Provider Business Mailing Address
First Line : 48150 THORNHILL LN
Second Line : APT 14
City : TICKFAW
State : LA
Zip : 70466-5137
Country : US
Telephone Number : 504-610-5361
Fax Number :
Provider Business Practice Location Address
First Line : 48150 THORNHILL LN
Second Line : APT 14
City : TICKFAW
State : LA
Zip : 70466-5137
Country : US
Telephone Number : 504-610-5361
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2011
Last Update Date : 10/20/2011

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Directions to “ KARTISIA ESCO ATC, LAT” Practice Location

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