Provider Demographics
NPI:1083949556
Name:PITRE, JULIE ELIZABETH (LMT, NCTMB)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ELIZABETH
Last Name:PITRE
Suffix:
Gender:F
Credentials:LMT, NCTMB
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:PITRE
Other - Last Name:BOUDREAUX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT, NCTMB
Mailing Address - Street 1:207 ESTATE DR
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70364-2837
Mailing Address - Country:US
Mailing Address - Phone:985-688-1516
Mailing Address - Fax:
Practice Address - Street 1:6860 W PARK AVE
Practice Address - Street 2:SUITE A
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70364-2623
Practice Address - Country:US
Practice Address - Phone:985-209-9338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-16
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2980225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist