Provider Demographics
NPI:1063661734
Name:BASS, MONICA L (PT)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:L
Last Name:BASS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8121 DUBOIS RD
Mailing Address - Street 2:
Mailing Address - City:KAPLAN
Mailing Address - State:LA
Mailing Address - Zip Code:70548-6485
Mailing Address - Country:US
Mailing Address - Phone:337-319-0340
Mailing Address - Fax:337-643-3110
Practice Address - Street 1:2002 JOHNSON ST
Practice Address - Street 2:STE. 100
Practice Address - City:JENNINGS
Practice Address - State:LA
Practice Address - Zip Code:70546-3640
Practice Address - Country:US
Practice Address - Phone:337-824-4547
Practice Address - Fax:337-824-4548
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA01623225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist