Healthcare Provider Details

I. General information

NPI: 1720187842
Provider Name (Legal Business Name): DANIELLE MARIE KYLE LAT, ATC, CSCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE MARIE PARMENTER LAT,ATC

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 10/07/2022
Certification Date: 10/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HENRY CLAY AVE
NEW ORLEANS LA
70118-5720
US

IV. Provider business mailing address

3621 POST OAK AVE
NEW ORLEANS LA
70131-8407
US

V. Phone/Fax

Practice location:
  • Phone: 504-896-9377
  • Fax:
Mailing address:
  • Phone: 970-690-9107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number309424
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License NumberAT3710
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: