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Individual

RENE AUGUST PONSAA III

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
ATC, LAT

Contact information

Practice address
36326 CRESTWAY AVE, PRAIRIEVILLE, LA 70769-3272
(985) 687-5348
Mailing address
36326 CRESTWAY AVE, PRAIRIEVILLE, LA 70769-3272

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
ATH200019
LA

Other

Enumeration date
12/01/2017
Last updated
12/01/2017
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