Provider Demographics
NPI:1033187406
Name:SOILEAU, JEAN PHILIPPE (PT)
Entity Type:Individual
Prefix:PROF
First Name:JEAN
Middle Name:PHILIPPE
Last Name:SOILEAU
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 52396
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-2396
Mailing Address - Country:US
Mailing Address - Phone:337-232-3111
Mailing Address - Fax:337-232-5400
Practice Address - Street 1:1400 REES ST
Practice Address - Street 2:SUITE D
Practice Address - City:BREAUX BRIDGE
Practice Address - State:LA
Practice Address - Zip Code:70517-4308
Practice Address - Country:US
Practice Address - Phone:337-442-6077
Practice Address - Fax:337-442-1224
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06798225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5H569CB92Medicare ID - Type UnspecifiedMEDICARE NUMBER
LAP00369532Medicare PIN