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General NPI Number Information
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NPI Number | 1790779049
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Entity Type | Individual
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Provider Name | JOSELITO LAUREL MERCADO PT
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Gender | Male
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Dates
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Enumeration Date | 09/01/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 100 S 2ND ST
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City | MONROE
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State | LA
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Zip | 71201-8537
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Country | US
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Telephone | 318-398-9675
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Fax | 318-398-9295
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Provider Business Mailing Address
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Address Line | PO BOX 2467
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City | MONROE
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State | LA
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Zip | 71207-2467
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Country | US
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Telephone | 318-398-9675
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Fax | 318-398-9295
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 01128F
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License Number State | LA
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