Provider Demographics
NPI:1497059075
Name:FUSELIER, JENNIFER K
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:K
Last Name:FUSELIER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:KENNARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:13418 HIGHWAY 190
Mailing Address - Street 2:
Mailing Address - City:KINDER
Mailing Address - State:LA
Mailing Address - Zip Code:70648-5437
Mailing Address - Country:US
Mailing Address - Phone:337-526-0154
Mailing Address - Fax:337-824-4548
Practice Address - Street 1:2002 JOHNSON ST
Practice Address - Street 2:STE. 100
Practice Address - City:JENNINGS
Practice Address - State:LA
Practice Address - Zip Code:70546-3640
Practice Address - Country:US
Practice Address - Phone:337-824-4547
Practice Address - Fax:337-824-4548
Is Sole Proprietor?:No
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00862225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist