Provider Demographics
NPI:1043492408
Name:GUILLORY, LISA M
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:GUILLORY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 DOUCET RD
Mailing Address - Street 2:A 2
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3444
Mailing Address - Country:US
Mailing Address - Phone:504-473-3316
Mailing Address - Fax:337-216-7787
Practice Address - Street 1:353 DOUCET RD
Practice Address - Street 2:A 2
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3444
Practice Address - Country:US
Practice Address - Phone:337-216-7758
Practice Address - Fax:337-216-7787
Is Sole Proprietor?:No
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06462225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist