Provider Demographics
NPI:1528347077
Name:DANTONI, LARRY (ATC)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:
Last Name:DANTONI
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 BOWIE RD
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-6712
Mailing Address - Country:US
Mailing Address - Phone:985-493-4502
Mailing Address - Fax:985-493-4505
Practice Address - Street 1:290 BOWIE RD
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-6712
Practice Address - Country:US
Practice Address - Phone:985-493-4502
Practice Address - Fax:985-493-4505
Is Sole Proprietor?:No
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAJ000252255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer