Provider Demographics
NPI:1124019344
Name:MOREAU, AL C III (PT)
Entity Type:Individual
Prefix:MR
First Name:AL
Middle Name:C
Last Name:MOREAU
Suffix:III
Gender:M
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:2335 CHURCH ST
Mailing Address - Street 2:STE G
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-2700
Mailing Address - Country:US
Mailing Address - Phone:225-654-8208
Mailing Address - Fax:225-654-4642
Practice Address - Street 1:2335 CHURCH ST
Practice Address - Street 2:STE G
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-2700
Practice Address - Country:US
Practice Address - Phone:225-654-8208
Practice Address - Fax:225-654-4642
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2008-01-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA04423225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1022641Medicaid
LA1022641Medicaid