Provider Demographics
NPI:1346392016
Name:ADOLPH, JOHNNIE (DPT)
Entity Type:Individual
Prefix:MR
First Name:JOHNNIE
Middle Name:
Last Name:ADOLPH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5941 BULLARD AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70128-2818
Mailing Address - Country:US
Mailing Address - Phone:504-244-0088
Mailing Address - Fax:504-244-0077
Practice Address - Street 1:5941 BULLARD AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70128-2818
Practice Address - Country:US
Practice Address - Phone:504-244-0088
Practice Address - Fax:504-244-0077
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4H585Medicare PIN