RUSSELL CARLISLE

THIBODAUX, LA
NPI1578988218
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: LA  ATH.200033)
Enumeration Date2014-03-04
Last Update Date2014-03-04
Business Address
-- RUSSELL CARLISLE ATC, LAT
602 N ACADIA RD
THIBODAUX, LA 70301-4847
Phone number: 985-447-5500
Mailing Address
-- RUSSELL CARLISLE ATC, LAT
123 WILLOW CT
RACELAND, LA 70394-2732
Phone number: 985-688-0478
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