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General NPI Number Information
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NPI Number | 1346895620
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Entity Type | Individual
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Provider Name | DANIEL ANTHONY LATOURELLE ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 08/05/2019
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Last Update Date | 08/05/2019
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Provider Practice Location Address
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Address Line | 712 HAYTER STREET
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City | NACOGDOCHES
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State | TX
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Zip | 75962-0001
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Country | US
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Telephone | 936-468-3784
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Fax |
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Provider Business Mailing Address
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Address Line | 4541 NE STALLINGS DR APT 701
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City | NACOGDOCHES
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State | TX
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Zip | 75965-1672
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Country | US
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Telephone | 707-758-4593
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT7935
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License Number State | TX
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