Provider Demographics
NPI:1710288352
Name:LABATUT, TINA ANN (PT)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:ANN
Last Name:LABATUT
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 1:7183 DONALDSON DR
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-8132
Mailing Address - Country:US
Mailing Address - Phone:225-644-0166
Mailing Address - Fax:225-644-4459
Practice Address - Street 1:7183 DONALDSON DR
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-8132
Practice Address - Country:US
Practice Address - Phone:225-644-0166
Practice Address - Fax:225-644-4459
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-13
Last Update Date:2010-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA01590225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist