Healthcare Provider Details

I. General information

NPI: 1962400820
Provider Name (Legal Business Name): LYNN HOCUTT INZERELLA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 10/14/2022
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 GORDON CROCKET DR
LAFAYETTE LA
70508-5162
US

IV. Provider business mailing address

413 GORDON CROCKET DR
LAFAYETTE LA
70508-5162
US

V. Phone/Fax

Practice location:
  • Phone: 337-837-7126
  • Fax: 337-453-4393
Mailing address:
  • Phone: 337-837-7126
  • Fax: 337-453-4393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00160R
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number00160R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: