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NPI Code Detail

MEDICARE: MR. LARRY DANTONI ATC

MEDICARE: MR. LARRY DANTONI 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 TrainerJ00025LA

General Provider Information

NPI Number : 1528347077
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. LARRY DANTONI ATC
Provider Business Mailing Address
First Line : 290 BOWIE RD
Second Line :
City : THIBODAUX
State : LA
Zip : 70301-6712
Country : US
Telephone Number : 985-493-4502
Fax Number : 985-493-4505
Provider Business Practice Location Address
First Line : 290 BOWIE RD
Second Line :
City : THIBODAUX
State : LA
Zip : 70301-6712
Country : US
Telephone Number : 985-493-4502
Fax Number : 985-493-4505
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2011
Last Update Date : 08/15/2011

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Directions to “ MR. LARRY DANTONI ATC” Practice Location

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