Provider Demographics
NPI:1619518677
Name:PIATTOLY, TAVIS J (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:TAVIS
Middle Name:J
Last Name:PIATTOLY
Suffix:
Gender:M
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WICKFIELD DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-6816
Mailing Address - Country:US
Mailing Address - Phone:504-250-3325
Mailing Address - Fax:
Practice Address - Street 1:3 WICKFIELD DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-6816
Practice Address - Country:US
Practice Address - Phone:504-250-3325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1652