Provider Demographics
NPI:1033447040
Name:PORTIER, LINDA MARIE (PTA)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:MARIE
Last Name:PORTIER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1672
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70727-1672
Mailing Address - Country:US
Mailing Address - Phone:225-907-4388
Mailing Address - Fax:
Practice Address - Street 1:17605 JACK VAUGHN RD
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:LA
Practice Address - Zip Code:70754-3135
Practice Address - Country:US
Practice Address - Phone:225-907-4388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-02
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA4343225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant