Provider Demographics
NPI:1518180322
Name:CEDOTAL, CHRISTINE MILLER (PT)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:MILLER
Last Name:CEDOTAL
Suffix:
Gender:F
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:PO BOX 668
Mailing Address - Street 2:
Mailing Address - City:LAROSE
Mailing Address - State:LA
Mailing Address - Zip Code:70373-0668
Mailing Address - Country:US
Mailing Address - Phone:985-856-1211
Mailing Address - Fax:
Practice Address - Street 1:11109 HWY. 308
Practice Address - Street 2:
Practice Address - City:LAROSE
Practice Address - State:LA
Practice Address - Zip Code:70373
Practice Address - Country:US
Practice Address - Phone:985-693-7272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00120R2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1068373Medicaid