Provider Demographics
NPI:1437498540
Name:MISTRETTA, STEVEN JOSEPH JR (DPT)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:JOSEPH
Last Name:MISTRETTA
Suffix:JR
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 1:1001 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4629
Mailing Address - Country:US
Mailing Address - Phone:985-868-1540
Mailing Address - Fax:985-876-0759
Practice Address - Street 1:1001 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4629
Practice Address - Country:US
Practice Address - Phone:985-868-1540
Practice Address - Fax:985-876-0759
Is Sole Proprietor?:No
Enumeration Date:2013-02-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH6557225100000X
LA09303R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA09303ROtherSTATE LICENSE