Healthcare Provider Details

I. General information

NPI: 1063525855
Provider Name (Legal Business Name): DAVID J GIARDINA A.T.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29301 N. DIXIE RANCH RD.
LACOMBE LA
70445-2290
US

IV. Provider business mailing address

415 WINGATE DR
BATON ROUGE LA
70815-6572
US

V. Phone/Fax

Practice location:
  • Phone: 985-871-4114
  • Fax:
Mailing address:
  • Phone: 225-615-7644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberJ00001
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: