Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 00250 | LA |
NPI | 1063544815 |
---|---|
Provider Name | Lisa Roussel Veron |
First Address | Baton Rouge, LA 70808-5750 |
Second Address | Baton Rouge, LA 70808-5750 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2007 |
Last Update Date | 08/07/2007 |