Healthcare Provider Details

I. General information

NPI: 1750661690
Provider Name (Legal Business Name): AVIGAIL USNER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2011
Last Update Date: 08/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8128 FLORIDA BLVD
DENHAM SPRINGS LA
70726-7865
US

IV. Provider business mailing address

8128 FLORIDA BLVD
DENHAM SPRINGS LA
70726-7865
US

V. Phone/Fax

Practice location:
  • Phone: 225-791-8666
  • Fax: 225-791-2891
Mailing address:
  • Phone: 225-791-8666
  • Fax: 225-791-2891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number03002F
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: