Provider Demographics
NPI:1164657037
Name:COULON, CHRISTIAN L (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:L
Last Name:COULON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39092 S ANGELLE CT
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-6194
Mailing Address - Country:US
Mailing Address - Phone:337-303-8150
Mailing Address - Fax:
Practice Address - Street 1:39092 S ANGELLE CT
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-6194
Practice Address - Country:US
Practice Address - Phone:337-303-8150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-21
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07262225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist