1477622520 NPI number — MRS. MAISIE HARGETT PT

Table of content: MRS. MAISIE HARGETT PT (NPI 1477622520)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477622520 NPI number — MRS. MAISIE HARGETT PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARGETT
Provider First Name:
MAISIE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MEAUX
Provider Other First Name:
MAISIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477622520
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2115 DULLES DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70506-2652
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-981-9182
Provider Business Mailing Address Fax Number:
337-988-3441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
327 IBERIA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YOUNGSVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70592-5738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-856-1717
Provider Business Practice Location Address Fax Number:
337-856-1818
Provider Enumeration Date:
11/06/2006

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:  LAPT07063 , 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)

  • Identifier: LAPT07063 . This is a "PHYSICAL THERAPY LICENSE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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