Healthcare Provider Details

I. General information

NPI: 1164341608
Provider Name (Legal Business Name): MARY KATHERINE COUVILLION DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 VEROT SCHOOL RD STE E
LAFAYETTE LA
70508-5094
US

IV. Provider business mailing address

626 VEROT SCHOOL RD STE E
LAFAYETTE LA
70508-5094
US

V. Phone/Fax

Practice location:
  • Phone: 337-406-0808
  • Fax: 337-406-0848
Mailing address:
  • Phone: 337-406-0808
  • Fax: 337-406-0848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12372
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: