Provider Demographics
NPI:1235316555
Name:MISTRETTA, HALEY BURLET (PT)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:BURLET
Last Name:MISTRETTA
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 1:102 CANAL LN
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70364-1107
Mailing Address - Country:US
Mailing Address - Phone:985-856-6337
Mailing Address - Fax:
Practice Address - Street 1:102 CANAL LN
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70364-1107
Practice Address - Country:US
Practice Address - Phone:985-856-6337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07253225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist