Provider Demographics
NPI:1073570164
Name:GAUNT, ANGELLE (PT)
Entity Type:Individual
Prefix:
First Name:ANGELLE
Middle Name:
Last Name:GAUNT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2113 COTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3636
Mailing Address - Country:US
Mailing Address - Phone:318-387-7104
Mailing Address - Fax:
Practice Address - Street 1:2113 COTTONWOOD DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3636
Practice Address - Country:US
Practice Address - Phone:318-614-8929
Practice Address - Fax:318-654-4359
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04698225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist