Provider Demographics
NPI:1518158278
Name:LAFLEUR, JEREMY JEDD (PT)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:JEDD
Last Name:LAFLEUR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 JACK MILLER RD
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-5635
Mailing Address - Country:US
Mailing Address - Phone:337-360-9711
Mailing Address - Fax:
Practice Address - Street 1:401 JACK MILLER RD
Practice Address - Street 2:
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586-5635
Practice Address - Country:US
Practice Address - Phone:337-360-9711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06888225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1455865Medicaid