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NPI Code Detail

MEDICARE: MRS. KRISTIE H CULPEPPER PT DPT MTC

MEDICARE: MRS. KRISTIE H CULPEPPER PT DPT MTC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist04515LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1G5372OTHERLABLUE CROSS BLUE SHIELD
2204969100OTHERLADEPT OF LABOR

General Provider Information

NPI Number : 1104964691
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KRISTIE H CULPEPPER PT DPT MTC
Provider Business Mailing Address
First Line : 6723 JEFFERSON HWY
Second Line :
City : BATON ROUGE
State : LA
Zip : 70806-8106
Country : US
Telephone Number : 225-926-2400
Fax Number : 225-926-2470
Provider Business Practice Location Address
First Line : 6723 JEFFERSON HWY
Second Line :
City : BATON ROUGE
State : LA
Zip : 70806-8106
Country : US
Telephone Number : 225-926-2400
Fax Number : 225-926-2470
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2007
Last Update Date : 09/22/2010

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