JONATHAN GANTT

HAMMOND, LA
NPI1992112031
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: LA  ATH.200223)
Enumeration Date2014-07-21
Last Update Date2014-07-21
Business Address
-- JONATHAN GANTT ATC, LAT
15813 PAUL VEGA MD DR STE 100
HAMMOND, LA 70403-1431
Phone number: 985-974-8993
Mailing Address
-- JONATHAN GANTT ATC, LAT
PO BOX 2668
HAMMOND, LA 70404-2668
Phone number: 985-974-8993
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