Healthcare Provider Details

I. General information

NPI: 1023348208
Provider Name (Legal Business Name): STANLEY JON LAGARDE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2010
Last Update Date: 01/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2775 S COLUMBIA RD
BOGALUSA LA
70427-7961
US

IV. Provider business mailing address

29301 N DIXIE RANCH RD
LACOMBE LA
70445-5403
US

V. Phone/Fax

Practice location:
  • Phone: 985-871-4114
  • Fax: 985-871-4130
Mailing address:
  • Phone: 985-871-4114
  • Fax: 985-871-4130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number00756
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: