Individual
TRAVIS EDWARD THERIOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, LAT, ATC
Contact information
Practice address
1747 IMPERIAL BLVD, LAKE CHARLES, LA 70605-5362
(337) 721-7236
Mailing address
1747 IMPERIAL BLVD, LAKE CHARLES, LA 70605-5362
(337) 329-3923
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
ATH.200301
LA
Other
Enumeration date
02/09/2022
Last updated
02/09/2022
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