Healthcare Provider Details

I. General information

NPI: 1285115592
Provider Name (Legal Business Name): ALEXANDRA DARBY FONTENOT P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 OLD JEANERETTE RD STE 102
NEW IBERIA LA
70563-5801
US

IV. Provider business mailing address

1307 OLD JEANERETTE RD STE 102
NEW IBERIA LA
70563-5801
US

V. Phone/Fax

Practice location:
  • Phone: 337-367-3331
  • Fax: 337-367-6494
Mailing address:
  • Phone: 337-367-3331
  • Fax: 337-367-6494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: