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General NPI Number Information
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NPI Number | 1386168128
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Entity Type | Individual
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Provider Name | ANNELISE DAVIES LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 08/02/2017
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Last Update Date | 08/02/2017
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Provider Practice Location Address
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Address Line | 500 W UNIVERSITY AVE
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City | HAMMOND
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State | LA
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Zip | 70401-1304
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Country | US
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Telephone | 985-549-2200
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Fax | 985-549-2511
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Provider Business Mailing Address
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Address Line | 901 PECAN ST APT 47
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City | HAMMOND
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State | LA
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Zip | 70401-2373
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Country | US
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Telephone | 215-284-4226
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Fax | 985-549-2511
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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 | ATH.200506
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License Number State | LA
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