Provider Demographics
NPI:1477755783
Name:LA BOUFF, PATRICIA ANN (PT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:LA BOUFF
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 1:8584 FANITA DR
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-4019
Mailing Address - Country:US
Mailing Address - Phone:619-807-5510
Mailing Address - Fax:
Practice Address - Street 1:4350 MOUNT EVEREST BLVD
Practice Address - Street 2:WIGGIN CENTER, B-11
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-4847
Practice Address - Country:US
Practice Address - Phone:858-573-5972
Practice Address - Fax:858-573-5985
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 7949225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist