MEDICARE: MRS. HOLLIS WALSDORF FOUSSE PTA

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	225200000X	Physical Therapy Assistant	PTA-010009	AZ
2	225200000X	Physical Therapy Assistant	A7726	LA

General Provider Information

NPI Number	:	1720611031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HOLLIS WALSDORF FOUSSE PTA

Provider Business Mailing Address
First Line	:	1906 CALVIN CT
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70607-7715
Country	:	US
Telephone Number	:	985-778-9306
Fax Number	:

Provider Business Practice Location Address
First Line	:	1714 WOLF CIR
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-2353
Country	:	US
Telephone Number	:	337-304-8024
Fax Number	:

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

Provider Enumeration Date	:	02/14/2020
Last Update Date	:	02/14/2020

Similar Medicare Providers

1033808852 — BLOOM BEHAVIORAL CENTER, LLC
Practice Location Address:

1734 WOLF CIR
LAKE CHARLES, LA
70605-2353

Practice Phone: 337-240-6038
Practice Fax:

1346231065 — DR. FARJAAD SIDDIQ M.D.
Practice Location Address:

1715 WOLF CIR
LAKE CHARLES, LA
70605-2353

Practice Phone: 337-480-7499
Practice Fax: 337-480-7498

1528254489 — MILDRED ELIZABETH HYDE MS CCC-SLP
Practice Location Address:

1714 WOLF CIR
LAKE CHARLES, LA
70605-2353

Practice Phone: 337-508-2505
Practice Fax: 337-508-2506

1255964110 — MAXX PHYSICAL THERAPY, LLC
Practice Location Address:

1714 WOLF CIR
LAKE CHARLES, LA
70605-2353

Practice Phone: 337-508-2505
Practice Fax:

1578186649 — ABBY LEWIS BELL
Practice Location Address:

1714 WOLF CIR
LAKE CHARLES, LA
70605-2353

Practice Phone: 375-082-5053
Practice Fax: 337-508-2506

1770192171 — MRS. CELESTE WOODARD BROWN FNP-C
Practice Location Address:

1715 WOLF CIR
LAKE CHARLES, LA
70605-2353

Practice Phone: 337-480-7499
Practice Fax: 337-480-7498

Directions to “ MRS. HOLLIS WALSDORF FOUSSE PTA” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.