Healthcare Provider Details

I. General information

NPI: 1215129952
Provider Name (Legal Business Name): MR. PHILIP B ARDOIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 08/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E MAIN ST
VILLE PLATTE LA
70586-4618
US

IV. Provider business mailing address

3686 FAUBOURG RD
WASHINGTON LA
70589-5511
US

V. Phone/Fax

Practice location:
  • Phone: 337-360-9711
  • Fax:
Mailing address:
  • Phone: 337-360-9711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number04431
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: