=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922779461
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | COURTNEY ST. PIERRE MISTRETTA DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2021
-----------------------------------------------------
Last Update Date | 09/27/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22128 HWY 20
-----------------------------------------------------
City | VACHERIE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70090
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-265-2400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 178
-----------------------------------------------------
City | VACHERIE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70090-0178
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-265-2400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | 10929
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------