Individual
JONATHAN GANTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
15813 PAUL VEGA MD DR STE 100, HAMMOND, LA 70403-1431
(985) 974-8993
Mailing address
PO BOX 2668, HAMMOND, LA 70404-2668
(985) 974-8993
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
ATH.200223
LA
Other
Enumeration date
07/21/2014
Last updated
07/21/2014
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