MEDICARE: ALLISON P BOULET MPT

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
1	225100000X	Physical Therapist	07320	LA

General Provider Information

NPI Number	:	1679754162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON P BOULET MPT

Provider Business Mailing Address
First Line	:	1322 ELTON RD
Second Line	:	SUITE I
City	:	JENNINGS
State	:	LA
Zip	:	70546-4100
Country	:	US
Telephone Number	:	337-824-5488
Fax Number	:	337-824-5494

Provider Business Practice Location Address
First Line	:	1322 ELTON RD
Second Line	:	SUITE I
City	:	JENNINGS
State	:	LA
Zip	:	70546-4100
Country	:	US
Telephone Number	:	337-824-5488
Fax Number	:	337-824-5494

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/26/2007
Last Update Date	:	11/26/2007

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Directions to “ ALLISON P BOULET MPT” Practice Location

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