Provider Demographics
NPI:1831680628
Name:RESWEBER, KATHRYN ANGELLE (ATC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANGELLE
Last Name:RESWEBER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 HARDING ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2320
Mailing Address - Country:US
Mailing Address - Phone:337-232-3111
Mailing Address - Fax:337-232-5400
Practice Address - Street 1:816 HARDING ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2320
Practice Address - Country:US
Practice Address - Phone:337-232-3111
Practice Address - Fax:337-232-5400
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2004782255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
BOC297444OtherATHLETIC TRAINER NATIONAL CERTIFICATION
LAATH200478OtherLOUISIANA ATHLETIC TRAINING