Provider Demographics
NPI:1760713762
Name:CANOVA, JAMIE SLATER (PT,DPT)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:SLATER
Last Name:CANOVA
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:41035 LAKEWAY COVE AVE
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-8947
Mailing Address - Country:US
Mailing Address - Phone:225-644-7044
Mailing Address - Fax:225-644-4414
Practice Address - Street 1:211 E WORTHY ST
Practice Address - Street 2:BUILDING 4
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-4232
Practice Address - Country:US
Practice Address - Phone:225-644-7044
Practice Address - Fax:225-644-4414
Is Sole Proprietor?:No
Enumeration Date:2010-01-15
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA07749225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist