Provider Demographics
NPI:1659966059
Name:LACOSTE, SARAH KAITLENN (PT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:KAITLENN
Last Name:LACOSTE
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 1:1151 BARATARIA BLVD STE 4300
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3084
Mailing Address - Country:US
Mailing Address - Phone:504-340-6976
Mailing Address - Fax:504-349-6786
Practice Address - Street 1:1151 BARATARIA BLVD STE 4300
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3084
Practice Address - Country:US
Practice Address - Phone:504-340-6976
Practice Address - Fax:504-349-6786
Is Sole Proprietor?:No
Enumeration Date:2021-03-08
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT7057225100000X
LACP015382T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist