Provider Demographics
NPI:1497834253
Name:PICKETT, ALBERT (DPT)
Entity Type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:
Last Name:PICKETT
Suffix:
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 1:17709 OLD JEFFERSON HWY STE A
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-3977
Mailing Address - Country:US
Mailing Address - Phone:225-677-8400
Mailing Address - Fax:225-677-8484
Practice Address - Street 1:17709 OLD JEFFERSON HWY STE A
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-3977
Practice Address - Country:US
Practice Address - Phone:225-677-8400
Practice Address - Fax:225-677-8484
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05095225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA212607OtherCOVENTRY
LA212607OtherCOVENTRY