MEDICARE: MS. PATRICIA BOULET 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
1	225100000X	Physical Therapist	PT0678	LA

General Provider Information

NPI Number	:	1629129994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICIA BOULET PT

Provider Business Mailing Address
First Line	:	300 STEINER RD
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-6017
Country	:	US
Telephone Number	:	337-264-9856
Fax Number	:	337-261-5042

Provider Business Practice Location Address
First Line	:	119 REPRESENTATIVE ROW
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-3833
Country	:	US
Telephone Number	:	337-264-9856
Fax Number	:	337-261-5042

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

Provider Enumeration Date	:	01/15/2007
Last Update Date	:	12/19/2007

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Directions to “ MS. PATRICIA BOULET PT” Practice Location

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