Provider Demographics
NPI:1558658617
Name:CRESSON, JEFFREY PAUL (DPT)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:PAUL
Last Name:CRESSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5404 HIGHWAY 22
Mailing Address - Street 2:STE 200
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-2518
Mailing Address - Country:US
Mailing Address - Phone:985-869-7221
Mailing Address - Fax:504-834-9281
Practice Address - Street 1:5404 HIGHWAY 22
Practice Address - Street 2:STE 200
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-2518
Practice Address - Country:US
Practice Address - Phone:985-869-7221
Practice Address - Fax:603-343-2130
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08048225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist