=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134437528
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TORI PASSMAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2010
-----------------------------------------------------
Last Update Date | 09/02/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2000 MAIN ST
-----------------------------------------------------
City | FRANKLINTON
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70438-1566
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-839-2463
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2000 MAIN ST
-----------------------------------------------------
City | FRANKLINTON
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70438-3620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | A7148
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------