Provider Demographics
NPI:1629129994
Name:BOULET, PATRICIA (PT)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:BOULET
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 1:300 STEINER RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6017
Mailing Address - Country:US
Mailing Address - Phone:337-264-9856
Mailing Address - Fax:337-261-5042
Practice Address - Street 1:119 REPRESENTATIVE ROW
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3833
Practice Address - Country:US
Practice Address - Phone:337-264-9856
Practice Address - Fax:337-261-5042
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPT0678225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5S746CT74Medicare PIN