MEDICARE: STEPHEN R COUVILLION JR. P.T.

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	04977	LA

General Provider Information

NPI Number	:	1801917760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN R COUVILLION JR. P.T.

Provider Business Mailing Address
First Line	:	3004 JACKSON ST
Second Line	:	SUITE A
City	:	ALEXANDRIA
State	:	LA
Zip	:	71301-4745
Country	:	US
Telephone Number	:	318-787-5952
Fax Number	:

Provider Business Practice Location Address
First Line	:	3004 JACKSON ST
Second Line	:	SUITE A
City	:	ALEXANDRIA
State	:	LA
Zip	:	71301-4745
Country	:	US
Telephone Number	:	318-787-5952
Fax Number	:

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

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	09/15/2010

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