Healthcare Provider Details

I. General information

NPI: 1174674758
Provider Name (Legal Business Name): CLAUDE TREMBLAY P.T., D.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 N LEWIS ST
NEW IBERIA LA
70563-2841
US

IV. Provider business mailing address

228 N LEWIS ST
NEW IBERIA LA
70563-2841
US

V. Phone/Fax

Practice location:
  • Phone: 337-364-7496
  • Fax: 337-364-7499
Mailing address:
  • Phone: 337-364-7496
  • Fax: 337-364-7499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number02780
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: