Healthcare Provider Details

I. General information

NPI: 1215846852
Provider Name (Legal Business Name): NICHOLAS J CRONAN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3212 2ND AVE
LAKE CHARLES LA
70601-8922
US

IV. Provider business mailing address

7108 SHADOW LN
LAKE CHARLES LA
70605-9089
US

V. Phone/Fax

Practice location:
  • Phone: 337-494-2556
  • Fax:
Mailing address:
  • Phone: 337-494-2556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number06746
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: