Healthcare Provider Details

I. General information

NPI: 1598700312
Provider Name (Legal Business Name): ANTHONY TODD NEESON MS, ATC, LAT, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17077 E LITTLE ITALY RD
HAMMOND LA
70403-6303
US

IV. Provider business mailing address

17077 E LITTLE ITALY RD
HAMMOND LA
70403-6303
US

V. Phone/Fax

Practice location:
  • Phone: 985-345-4084
  • Fax:
Mailing address:
  • Phone: 985-345-4084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number985228
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: