Healthcare Provider Details

I. General information

NPI: 1528809811
Provider Name (Legal Business Name): AHNI MIRE SENECA MS, LAT, ATC, CSCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AHNI MARIE MIRE MS, LAT, ATC, CSCS

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 E 1ST ST
THIBODAUX LA
70301-6701
US

IV. Provider business mailing address

906 E 1ST ST
THIBODAUX LA
70301-6701
US

V. Phone/Fax

Practice location:
  • Phone: 877-642-4655
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: