Provider Demographics
NPI:1275194243
Name:FRIDDLE, ELISE MCDONNER (DPT, PT)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:MCDONNER
Last Name:FRIDDLE
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6764 LONE OAK DR
Mailing Address - Street 2:
Mailing Address - City:ERWINVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70729-2642
Mailing Address - Country:US
Mailing Address - Phone:225-229-5517
Mailing Address - Fax:
Practice Address - Street 1:400 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:NEW ROADS
Practice Address - State:LA
Practice Address - Zip Code:70760-2623
Practice Address - Country:US
Practice Address - Phone:225-638-4404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09628225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist