Healthcare Provider Details

I. General information

NPI: 1538074380
Provider Name (Legal Business Name): LAURA POUDRIER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9058 SHREVEPORT HWY
LEESVILLE LA
71446-1812
US

IV. Provider business mailing address

9058 SHREVEPORT HWY
LEESVILLE LA
71446-1812
US

V. Phone/Fax

Practice location:
  • Phone: 337-239-3460
  • Fax: 337-239-3462
Mailing address:
  • Phone: 337-239-3460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12038
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: