Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 08113 | LA |
N | 2251N0400X | Physical Therapist - Neurology | 08113 | LA |
NPI | 1538772561 |
---|---|
Provider Name | Mr. Joshua Kevin Berthelot |
First Address | Metairie, LA 70005-1044 |
Second Address | New Orleans, LA 70119-6535 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2020 |
Last Update Date | 28/08/2020 |