Provider Demographics
NPI:1649564816
Name:GASPARD, MAGGIE JEAN (DPT)
Entity Type:Individual
Prefix:MRS
First Name:MAGGIE
Middle Name:JEAN
Last Name:GASPARD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:MAGGIE
Other - Middle Name:JEAN
Other - Last Name:FREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:441 MOOSA BLVD
Mailing Address - Street 2:
Mailing Address - City:EUNICE
Mailing Address - State:LA
Mailing Address - Zip Code:70535-3627
Mailing Address - Country:US
Mailing Address - Phone:337-457-8164
Mailing Address - Fax:337-546-6515
Practice Address - Street 1:441 MOOSA BLVD
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-3627
Practice Address - Country:US
Practice Address - Phone:337-457-8164
Practice Address - Fax:337-546-6515
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08051225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA$$$$$$$$$OOtherBCBS OF LA
LA$$$$$$$$$OOtherBCBS OF LA