Provider Demographics
NPI:1629244942
Name:DESPORTE, DAVID K (MPT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:K
Last Name:DESPORTE
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 LAPALCO BOULEVARD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-6125
Mailing Address - Country:US
Mailing Address - Phone:504-366-3302
Mailing Address - Fax:504-366-3311
Practice Address - Street 1:2330 LAPALCO BOULEVARD
Practice Address - Street 2:SUITE 10
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-6125
Practice Address - Country:US
Practice Address - Phone:504-366-3302
Practice Address - Fax:504-366-3311
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPT07309225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist