1639770613 NPI number — CONNER LYNN SCHEUERMANN PT

Table of content: CONNER LYNN SCHEUERMANN PT (NPI 1639770613)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639770613 NPI number — CONNER LYNN SCHEUERMANN PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHEUERMANN
Provider First Name:
CONNER
Provider Middle Name:
LYNN
Provider Name Prefix Text:
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:
LUSCY
Provider Other First Name:
CONNER
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639770613
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/05/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 80964
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:
70598-0964
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-233-7977
Provider Business Mailing Address Fax Number:
337-233-7978

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19345 SUNSHINE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COVINGTON
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70433-8834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-809-3940
Provider Business Practice Location Address Fax Number:
985-809-3942
Provider Enumeration Date:
11/05/2020

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:  10640 , 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: 10640 . This is a "PHYSICAL THERAPY LICENSE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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