Provider Demographics
NPI:1477622520
Name:HARGETT, MAISIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:MAISIE
Middle Name:
Last Name:HARGETT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:MAISIE
Other - Middle Name:
Other - Last Name:MEAUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2115 DULLES DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-2652
Mailing Address - Country:US
Mailing Address - Phone:337-981-9182
Mailing Address - Fax:337-988-3441
Practice Address - Street 1:327 IBERIA ST
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:LA
Practice Address - Zip Code:70592-5738
Practice Address - Country:US
Practice Address - Phone:337-856-1717
Practice Address - Fax:337-856-1818
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALAPT07063225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LALAPT07063OtherPHYSICAL THERAPY LICENSE