Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 00759 | LA |
NPI | 1043301039 |
---|---|
Provider Name | Mr. Lance Paul Lemoine JR. |
First Address | Baton Rouge, LA 70808-4954 |
Second Address | Baton Rouge, LA 70808-4954 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 07/04/2011 |