Healthcare Provider Details

I. General information

NPI: 1548685472
Provider Name (Legal Business Name): RORY MCHARDY ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2014
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10310 THE GROVE BLVD
BATON ROUGE LA
70836-6455
US

IV. Provider business mailing address

10310 THE GROVE BLVD
BATON ROUGE LA
70836-6455
US

V. Phone/Fax

Practice location:
  • Phone: 225-761-5200
  • Fax: 225-761-5702
Mailing address:
  • Phone: 225-761-5200
  • Fax: 225-761-5702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number13-0624
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT002297
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: