=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376778464
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANNE MARIE BIRO PTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2009
-----------------------------------------------------
Last Update Date | 05/19/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 170 ATLAS ROAD
-----------------------------------------------------
City | YOUNGSVILLE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70592
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-856-0456
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 170 ATLAS RD
-----------------------------------------------------
City | YOUNGSVILLE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70592-5257
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-856-0456
-----------------------------------------------------
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 | A1982G
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------