MEDICARE: SOPHIA GIRARDEAU DPT

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
1	225100000X	Physical Therapist	10010	LA

General Provider Information

NPI Number	:	1164900197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIA GIRARDEAU DPT

Provider Business Mailing Address
First Line	:	8448 SIEGEN LN
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70810-1938
Country	:	US
Telephone Number	:	225-767-8182
Fax Number	:

Provider Business Practice Location Address
First Line	:	31985 LA HIGHWAY 16 STE C
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-1462
Country	:	US
Telephone Number	:	225-791-7114
Fax Number	:	225-791-7118

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2018
Last Update Date	:	08/01/2018

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