Individual
KENNETH TRAHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
833 LEE DR, PONCHATOULA, LA 70454-8123
(985) 981-1466
Mailing address
833 LEE DR, PONCHATOULA, LA 70454-8123
(985) 981-1466
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
J00331
LA
Other
Enumeration date
05/27/2022
Last updated
05/27/2022
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