Provider Demographics
NPI:1164920385
Name:PIERSON, NEIL WILLIAM
Entity Type:Individual
Prefix:MR
First Name:NEIL
Middle Name:WILLIAM
Last Name:PIERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 JADE CT
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-3128
Mailing Address - Country:US
Mailing Address - Phone:504-261-7668
Mailing Address - Fax:
Practice Address - Street 1:501 S LOCUST ST
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-4336
Practice Address - Country:US
Practice Address - Phone:601-680-0348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA4062225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant