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NPI Code Detail

MEDICARE: ANNELISE DAVIES LAT, ATC

MEDICARE: ANNELISE DAVIES LAT, ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic TrainerATH.200506LA

General Provider Information

NPI Number : 1386168128
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNELISE DAVIES LAT, ATC
Provider Business Mailing Address
First Line : 901 PECAN ST APT 47
Second Line :
City : HAMMOND
State : LA
Zip : 70401-2373
Country : US
Telephone Number : 215-284-4226
Fax Number : 985-549-2511
Provider Business Practice Location Address
First Line : 500 W UNIVERSITY AVE
Second Line :
City : HAMMOND
State : LA
Zip : 70401-1304
Country : US
Telephone Number : 985-549-2200
Fax Number : 985-549-2511
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2017
Last Update Date : 08/02/2017

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