Provider Demographics
NPI:1629143151
Name:CHERALLA, CARMEN LOUISE (PT)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:LOUISE
Last Name:CHERALLA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:LOUISE
Other - Last Name:HEBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6756 LANGLEY DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-5178
Mailing Address - Country:US
Mailing Address - Phone:225-295-8183
Mailing Address - Fax:
Practice Address - Street 1:11320 INDUSTRIPLEX BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-4108
Practice Address - Country:US
Practice Address - Phone:225-295-8183
Practice Address - Fax:225-295-8236
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07114225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist