Provider Demographics
NPI:1265632681
Name:SIMPSON, SUE LYN (PT)
Entity Type:Individual
Prefix:MRS
First Name:SUE
Middle Name:LYN
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:SUE
Other - Middle Name:LYN
Other - Last Name:BOLDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:45154 BATEMAN LN
Mailing Address - Street 2:
Mailing Address - City:SAINT AMANT
Mailing Address - State:LA
Mailing Address - Zip Code:70774-4236
Mailing Address - Country:US
Mailing Address - Phone:225-715-9333
Mailing Address - Fax:
Practice Address - Street 1:45154 BATEMAN LN
Practice Address - Street 2:
Practice Address - City:SAINT AMANT
Practice Address - State:LA
Practice Address - Zip Code:70774-4236
Practice Address - Country:US
Practice Address - Phone:225-715-9333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2018-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA02268225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist