Rene August Ponsaa III, ATC, LAT
Specialist/Technologist, Athletic Trainer in Prairieville, LA. Individual provider (NPI-1).
NPI number1861906695
StatusActive
Last updated in NPPESDec 1, 2017
Details
- NPI
- 1861906695
- Entity type
- Individual (NPI-1)
- Name
- Rene August Ponsaa III
- Credential
- ATC, LAT
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Dec 1, 2017
- Last updated
- Dec 1, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2255A2300X | Specialist/Technologist, Athletic Trainer | ATH200019 | LA | Yes |
Practice location
36326 Crestway AvePrairieville, LA 70769-3272
Phone 985-687-5348
Mailing address
36326 Crestway AvePrairieville, LA 70769-3272
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