Healthcare Provider Details

I. General information

NPI: 1720498751
Provider Name (Legal Business Name): DANA KIRSCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2014
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15813 PAUL VEGA MD DR SUITE 100
HAMMOND LA
70403-1426
US

IV. Provider business mailing address

PO BOX 3087
HAMMOND LA
70404-3087
US

V. Phone/Fax

Practice location:
  • Phone: 985-230-2663
  • Fax: 985-230-2665
Mailing address:
  • Phone: 985-230-2663
  • Fax: 985-230-2665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number08102
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: