Provider Demographics
NPI:1700859568
Name:DAIGLE, JOHN L (PT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:L
Last Name:DAIGLE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:606 FAIRWAY
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301
Mailing Address - Country:US
Mailing Address - Phone:985-447-3276
Mailing Address - Fax:985-447-5196
Practice Address - Street 1:808 BAYOU LN
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4906
Practice Address - Country:US
Practice Address - Phone:985-447-3164
Practice Address - Fax:985-447-5196
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA01402225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5T790Medicare ID - Type Unspecified