Individual
RAEGAN WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
906 E 1ST ST, THIBODAUX, LA 70301-6701
(985) 448-4507
Mailing address
16923 EVERGREEN HILLS AVE, GREENWELL SPRINGS, LA 70739-3920
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
334488
LA
Other
Enumeration date
07/23/2024
Last updated
07/23/2024
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