Provider Demographics
NPI:1508976879
Name:TRAHAN, JANE ELIZABETH (PTA)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:ELIZABETH
Last Name:TRAHAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 SHORTCUT HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-8047
Mailing Address - Country:US
Mailing Address - Phone:985-641-3818
Mailing Address - Fax:985-641-3891
Practice Address - Street 1:1601 SHORTCUT HWY
Practice Address - Street 2:SUITE B
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-8047
Practice Address - Country:US
Practice Address - Phone:985-641-3818
Practice Address - Fax:985-641-3891
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA1975G225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAA1975GOtherSTATE LICENSE