Healthcare Provider Details

I. General information

NPI: 1679986780
Provider Name (Legal Business Name): COURTNEY LYNN RAUSCHKOLB LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 06/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 S CLEARVIEW PKWY BUILDING B, SUITE 104
JEFFERSON LA
70121-1015
US

IV. Provider business mailing address

1201 S CLEARVIEW PKWY BUILDING B, SUITE 104
JEFFERSON LA
70121-1015
US

V. Phone/Fax

Practice location:
  • Phone: 504-736-4800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberATH.200137
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: