Provider Demographics
NPI:1518214139
Name:LETOURNEAU, THOMAS (CPO, LPO)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:LETOURNEAU
Suffix:
Gender:M
Credentials:CPO, LPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2554 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1606
Mailing Address - Country:US
Mailing Address - Phone:409-833-3439
Mailing Address - Fax:409-833-1344
Practice Address - Street 1:2554 HARRISON ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1606
Practice Address - Country:US
Practice Address - Phone:409-833-3439
Practice Address - Fax:409-833-1344
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist