Provider Demographics
NPI:1417925033
Name:LEBAS, ANTHONY PAUL (PT)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:PAUL
Last Name:LEBAS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 ROBLEY DR
Mailing Address - Street 2:SUITE 135
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-5200
Mailing Address - Country:US
Mailing Address - Phone:337-991-0102
Mailing Address - Fax:337-991-0032
Practice Address - Street 1:4400 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:BOX 578
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6760
Practice Address - Country:US
Practice Address - Phone:337-991-0102
Practice Address - Fax:337-991-0032
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA02694225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA02694OtherPHYSICAL THERAPY LICENSE