Individual provider · NPI-1

John Daniel Boudreaux, PT, ATC, LAT

Physical Therapist · Lafayette, LA

NPI number1730116617
StatusActive
Last updated in NPPESAug 6, 2013

Details

NPI
1730116617
Entity type
Individual (NPI-1)
Name
Mr. John Daniel Boudreaux
Credential
PT, ATC, LAT
Sex
Male
Sole proprietor
No
Enumeration date
Jun 27, 2006
Last updated
Aug 6, 2013

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
225100000X Physical Therapist06867LAYes
2255A2300X Specialist/Technologist, Athletic Trainerj00368LA

Practice location

816 Harding St
Lafayette, LA 70503-2320

Phone 337-232-3111 · Fax 337-232-5400

Mailing address

124 Meadowbrook Dr
Broussard, LA 70518-4791

Phone 337-802-5652

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