1518604958 NPI number — MR. JOHN LUKE FRYOUX MSA, LAT, ATC

Table of content: MR. JOHN LUKE FRYOUX MSA, LAT, ATC (NPI 1518604958)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518604958 NPI number — MR. JOHN LUKE FRYOUX MSA, LAT, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRYOUX
Provider First Name:
JOHN
Provider Middle Name:
LUKE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MSA, LAT, ATC
Provider Gender Code:
M

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:
1518604958
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10077 JUBAN CROSSING BLVD APT 604
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENHAM SPRINGS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70726-8039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-335-2370
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12035 LA-431
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST. AMANT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70774
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-391-6000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/17/2022

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: 207PS0010X , with the licence number:  320899 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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