Provider Demographics
NPI:1225280357
Name:TUPPER, GAYLA FAIDLEY (PT)
Entity Type:Individual
Prefix:MRS
First Name:GAYLA
Middle Name:FAIDLEY
Last Name:TUPPER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10957 FERNBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3905
Mailing Address - Country:US
Mailing Address - Phone:225-292-0283
Mailing Address - Fax:
Practice Address - Street 1:10957 FERNBROOK AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3905
Practice Address - Country:US
Practice Address - Phone:225-292-0283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00881225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist