Provider Demographics
NPI:1508449638
Name:LEBLANC, HALEY FONTENOT (PT, DPT)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:FONTENOT
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:
Other - Last Name:FONTENOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:6756 LANGLEY DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-5178
Mailing Address - Country:US
Mailing Address - Phone:225-749-8980
Mailing Address - Fax:225-749-9096
Practice Address - Street 1:4463 HWY 1 S STE D
Practice Address - Street 2:
Practice Address - City:PORT ALLEN
Practice Address - State:LA
Practice Address - Zip Code:70767-5990
Practice Address - Country:US
Practice Address - Phone:225-749-8980
Practice Address - Fax:225-749-9096
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10868225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA10868OtherPT LICENSE