Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 04522 | LA |
NPI | 1134252265 |
---|---|
Provider Name | Mrs. Ashley Fabre Larson |
First Address | Baton Rouge, LA 70820-5057 |
Second Address | Baton Rouge, LA 70820-5057 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1314935 | (05) | LA |