Provider Demographics
NPI:1598768954
Name:BOURGEOIS, TROY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:
Last Name:BOURGEOIS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 VETERANS MEMORIAL BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-3060
Mailing Address - Country:US
Mailing Address - Phone:504-834-9259
Mailing Address - Fax:504-834-9281
Practice Address - Street 1:321 VETERANS MEMORIAL BLVD STE 100
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-3060
Practice Address - Country:US
Practice Address - Phone:504-834-9259
Practice Address - Fax:504-834-9281
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA048602251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1460192Medicaid
LA1460192Medicaid