MEDICARE: LADARIAN GAINES

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
1	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1639002819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LADARIAN GAINES

Provider Business Mailing Address
First Line	:	2025 HUNTER RD APT 9106
Second Line	:
City	:	NEW BRAUNFELS
State	:	TX
Zip	:	78132-3160
Country	:	US
Telephone Number	:	469-316-1716
Fax Number	:

Provider Business Practice Location Address
First Line	:	2025 HUNTER RD APT 9106
Second Line	:
City	:	NEW BRAUNFELS
State	:	TX
Zip	:	78132-3160
Country	:	US
Telephone Number	:	469-316-1716
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2026
Last Update Date	:	06/05/2026

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