Individual
DOMINIQUE RICHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3429 JERSEY DR, ZACHARY, LA 70791-4209
(225) 636-6367
Mailing address
3429 JERSEY DR, ZACHARY, LA 70791-4209
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
09/21/2015
Last updated
09/21/2015
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