Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 05224 | LA |
NPI | 1114239860 |
---|---|
Provider Name | Nicole Barkerding |
First Address | Covington, LA 70433-5060 |
Second Address | Covington, LA 70433-5060 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2010 |
Last Update Date | 10/07/2010 |