Provider Demographics
NPI:1730301771
Name:SEPULVADO, MARIETTA ARLENE (PTA)
Entity Type:Individual
Prefix:MS
First Name:MARIETTA
Middle Name:ARLENE
Last Name:SEPULVADO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39444 HESS RD
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70706-0278
Mailing Address - Country:US
Mailing Address - Phone:225-490-3424
Mailing Address - Fax:
Practice Address - Street 1:333 LEE DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4980
Practice Address - Country:US
Practice Address - Phone:225-490-3424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA4892225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant