Healthcare Provider Details

I. General information

NPI: 1437256427
Provider Name (Legal Business Name): ANDRE' LABBE' PTMOMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 05/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 WALL BLVD SUITE B
GRETNA LA
70056-7106
US

IV. Provider business mailing address

663 DODGE AVE
JEFFERSON LA
70121-1209
US

V. Phone/Fax

Practice location:
  • Phone: 504-392-0206
  • Fax: 504-392-0289
Mailing address:
  • Phone: 504-818-2300
  • Fax: 504-818-0022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number01391
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: