=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518193655
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | COURTNEY LYNN HOPE-BOURGEOIS PT, DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2009
-----------------------------------------------------
Last Update Date | 10/27/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1227 E HIGHWAY 30
-----------------------------------------------------
City | GONZALES
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70737-4761
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-743-2060
-----------------------------------------------------
Fax | 225-743-2065
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1227 E HIGHWAY 30
-----------------------------------------------------
City | GONZALES
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70737-4761
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-743-2060
-----------------------------------------------------
Fax | 225-743-2065
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 07569
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------