Provider Demographics
NPI:1083674923
Name:BOURGEOIS, MARJORIE L (PT05/12/1946)
Entity Type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:L
Last Name:BOURGEOIS
Suffix:
Gender:F
Credentials:PT05/12/1946
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 299
Mailing Address - Street 2:
Mailing Address - City:CHURCH POINT
Mailing Address - State:LA
Mailing Address - Zip Code:70525-0299
Mailing Address - Country:US
Mailing Address - Phone:337-684-6585
Mailing Address - Fax:337-684-6585
Practice Address - Street 1:119 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHURCH POINT
Practice Address - State:LA
Practice Address - Zip Code:70525-3113
Practice Address - Country:US
Practice Address - Phone:337-684-6585
Practice Address - Fax:337-684-6585
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPT-00219225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist