1235437336 NPI number — KATI ELIZABETH LEBOUEF DPT

Table of content: KATI ELIZABETH LEBOUEF DPT (NPI 1235437336)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235437336 NPI number — KATI ELIZABETH LEBOUEF DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEBOUEF
Provider First Name:
KATI
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235437336
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1221 KRIN AVE.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-802-2106
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1930 EDWARDS LAKE RD
Provider Second Line Business Practice Location Address:
SUITE 136
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35235-3718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-655-7231
Provider Business Practice Location Address Fax Number:
205-655-7232
Provider Enumeration Date:
03/14/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PTH6076 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)