Provider Demographics
NPI:1538306741
Name:DESONIER, EMERY R (PT)
Entity Type:Individual
Prefix:
First Name:EMERY
Middle Name:R
Last Name:DESONIER
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 1:1717 E PRIEN LAKE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-0400
Mailing Address - Country:US
Mailing Address - Phone:337-478-5880
Mailing Address - Fax:337-478-5879
Practice Address - Street 1:1717 E PRIEN LAKE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-0400
Practice Address - Country:US
Practice Address - Phone:337-478-5880
Practice Address - Fax:337-478-5879
Is Sole Proprietor?:No
Enumeration Date:2009-01-09
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04926225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4C489Medicare PIN