Most Relevant Information
Provider Data
| NPI Number: | 1003265810 |
| Provider Name: | RYAN TRAHAN LAT,ATC |
| Entity Type: | Individual |
| Taxonomy Code: | 2255A2300X |
| Specialty: | Specialist/Technologist |
| License Number: | ATH.200279 |
Most Important Dates
| Enumeration Date: | 06/13/2016 |
| Last Updated: | 06/13/2016 |
Provider Practice Location
602 N ACADIA RD
THIBODAUX
LA
703014823
Practice Location Phone/Fax
| Phone: | 9854934502 |
| Fax: |
Provider Mailing Location
1748 RIDGEFIELD AVE
THIBODAUX
LA
703015302
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |