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General NPI Number Information
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NPI Number | 1629577655
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Entity Type | Individual
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Provider Name | TRAVIS JAMES ROUSSELLE
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Gender | Male
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Dates
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Enumeration Date | 02/05/2018
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Last Update Date | 06/13/2025
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Provider Practice Location Address
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Address Line | 3939 HOUMA BLVD
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City | METAIRIE
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State | LA
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Zip | 70006-2931
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Country | US
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Telephone | 504-885-9121
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Fax |
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Provider Business Mailing Address
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Address Line | 5419 EHRET RD
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City | MARRERO
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State | LA
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Zip | 70072-5309
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Country | US
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Telephone |
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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 | 310149
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License Number State | LA
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