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NPI Code Detail

MEDICARE: ELISE MCDONNER FRIDDLE DPT, PT

MEDICARE: ELISE MCDONNER FRIDDLE DPT, PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist09628LA

General Provider Information

NPI Number : 1275194243
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELISE MCDONNER FRIDDLE DPT, PT
Provider Business Mailing Address
First Line : 6764 LONE OAK DR
Second Line :
City : ERWINVILLE
State : LA
Zip : 70729-2642
Country : US
Telephone Number : 225-229-5517
Fax Number :
Provider Business Practice Location Address
First Line : 400 HOSPITAL RD
Second Line :
City : NEW ROADS
State : LA
Zip : 70760-2623
Country : US
Telephone Number : 225-638-4404
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2019
Last Update Date : 06/21/2019

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