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NPI Code Detail

MEDICARE: DUSTI NECK PT

MEDICARE:   DUSTI  NECK  PT
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 Therapist05027LA

General Provider Information

NPI Number : 1356310569
Entity Type Code : Individual
Provider Name (Legal Business Name) : DUSTI NECK PT
Provider Business Mailing Address
First Line : 2115 DULLES DR
Second Line :
City : LAFAYETTE
State : LA
Zip : 70506-2652
Country : US
Telephone Number : 337-981-9182
Fax Number : 337-988-3441
Provider Business Practice Location Address
First Line : 2115 DULLES DR
Second Line :
City : LAFAYETTE
State : LA
Zip : 70506-2652
Country : US
Telephone Number : 337-981-9182
Fax Number : 337-988-3441
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2006
Last Update Date : 07/08/2007

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Directions to “ DUSTI NECK PT” Practice Location

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