Provider Demographics
NPI:1073608311
Name:BECNEL, THERESA BOUQUET (PT)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:BOUQUET
Last Name:BECNEL
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 1:174 LAKE MECHANT CT
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-8325
Mailing Address - Country:US
Mailing Address - Phone:985-851-5365
Mailing Address - Fax:
Practice Address - Street 1:116 TWIN OAKS DR
Practice Address - Street 2:
Practice Address - City:RACELAND
Practice Address - State:LA
Practice Address - Zip Code:70394-2760
Practice Address - Country:US
Practice Address - Phone:985-537-7012
Practice Address - Fax:985-537-4145
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00386225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4C096CA71Medicare ID - Type Unspecified