Individual
RUSSELL CARLISLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
602 N ACADIA RD, THIBODAUX, LA 70301-4847
(985) 447-5500
Mailing address
123 WILLOW CT, RACELAND, LA 70394-2732
(985) 688-0478
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
ATH.200033
LA
Other
Enumeration date
03/04/2014
Last updated
03/04/2014
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