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General NPI Number Information
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NPI Number | 1104270453
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Entity Type | Individual
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Provider Name | JEFFERY LEDET PTA
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Gender | Male
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Dates
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Enumeration Date | 04/22/2016
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Last Update Date | 04/22/2016
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Provider Practice Location Address
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Address Line | 414 AVENUE B
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City | BOGALUSA
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State | LA
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Zip | 70427-3702
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Country | US
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Telephone | 985-732-1651
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Fax | 985-241-5400
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Provider Business Mailing Address
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Address Line | 414 AVENUE B
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City | BOGALUSA
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State | LA
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Zip | 70427-3702
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Country | US
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Telephone | 985-732-1651
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Fax | 985-241-5400
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A3626
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License Number State | LA
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