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NPI Code Detail

MEDICARE: ANGELICA LIRETTE DPT

MEDICARE: ANGELICA LIRETTE DPT
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 Therapist07170LA

General Provider Information

NPI Number : 1396678447
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELICA LIRETTE DPT
Provider Business Mailing Address
First Line : 132 S 6TH ST
Second Line :
City : PONCHATOULA
State : LA
Zip : 70454-3317
Country : US
Telephone Number : 985-386-6884
Fax Number :
Provider Business Practice Location Address
First Line : 132 S 6TH ST
Second Line :
City : PONCHATOULA
State : LA
Zip : 70454-3317
Country : US
Telephone Number : 985-386-6884
Fax Number : 985-386-6854
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2026
Last Update Date : 06/08/2026

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Directions to “ ANGELICA LIRETTE DPT” Practice Location

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