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1417174392
KEVIN DEE MANGUM
METAIRIE, LA
NPI
1417174392
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: LA ATH.J00034)
Enumeration Date
2007-04-20
Last Update Date
2007-07-08
Business Address
Mr. KEVIN DEE MANGUM ATC LAT
5800 AIRLINE DR
METAIRIE, LA 70003-3876
Phone number: 504-733-0255
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Mailing Address
Mr. KEVIN DEE MANGUM ATC LAT
5325 COCOS PLUMOSAS DR
KENNER, LA 70065-2320
Phone number: 504-885-9111
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