Provider Demographics
NPI:1639735871
Name:PRIMEAUX, CHRISTOPHER K (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:K
Last Name:PRIMEAUX
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 HERMITAGE AVE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-6626
Mailing Address - Country:US
Mailing Address - Phone:337-936-5380
Mailing Address - Fax:
Practice Address - Street 1:110 HERMITAGE AVE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-6626
Practice Address - Country:US
Practice Address - Phone:337-936-5380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA02658225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist