Provider Demographics
NPI:1275700767
Name:SCARLE, KRISTIN KENT (PT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:KENT
Last Name:SCARLE
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 1:1624 AUDUBON PKWY
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-3262
Mailing Address - Country:US
Mailing Address - Phone:225-241-4212
Mailing Address - Fax:
Practice Address - Street 1:770 GAUSE BLVD STE F
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2855
Practice Address - Country:US
Practice Address - Phone:985-649-9123
Practice Address - Fax:985-649-9129
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05176225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist