Individual
ZACHERY DALE STANDIFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
468 CASPARI DRIVE, NATCHITOCHES, LA 71497-4271
(318) 357-4035
Mailing address
2122 BERTHA ST, OPELOUSAS, LA 70570-9735
(337) 692-5742
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
324095
LA
2255A2300X
Athletic Trainer
—
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/17/2018
Last updated
08/12/2020
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