Healthcare Provider Details

I. General information

NPI: 1992792790
Provider Name (Legal Business Name): RUUD VUIJSTERS RPT MT PRACTICE OF PAIN MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 06/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 RUE BEAUREGARD STE. E
LAFAYETTE LA
70508-3284
US

IV. Provider business mailing address

218 RUE BEAUREGARD STE. E
LAFAYETTE LA
70508-3284
US

V. Phone/Fax

Practice location:
  • Phone: 337-264-6282
  • Fax:
Mailing address:
  • Phone: 337-264-6282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. RUUD VUIJSTERS
Title or Position: PT OWNER
Credential: PT
Phone: 337-264-6282