Provider Demographics
NPI:1174862098
Name:VAUSSINE, KIMBERLY IRENE (DPT)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:IRENE
Last Name:VAUSSINE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:IRENE
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:4080 NELSON RD STE 500
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-2440
Mailing Address - Country:US
Mailing Address - Phone:337-494-7546
Mailing Address - Fax:337-494-7548
Practice Address - Street 1:4080 NELSON RD STE 500
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-2440
Practice Address - Country:US
Practice Address - Phone:337-494-7546
Practice Address - Fax:337-494-7548
Is Sole Proprietor?:No
Enumeration Date:2013-02-13
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08512225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist