Provider Demographics
NPI:1225088487
Name:NEUROPEDS
Entity Type:Organization
Organization Name:NEUROPEDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:CULVER
Authorized Official - Last Name:DENICOLO
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:985-727-0097
Mailing Address - Street 1:1740 N CAUSEWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-3110
Mailing Address - Country:US
Mailing Address - Phone:985-727-0097
Mailing Address - Fax:985-727-5006
Practice Address - Street 1:1740 N CAUSEWAY BLVD
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3110
Practice Address - Country:US
Practice Address - Phone:985-727-0097
Practice Address - Fax:985-727-5006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CR79Medicare ID - Type UnspecifiedPT/OT OUTPATIENT