Provider Demographics
NPI:1760828107
Name:AUDET, LOUISE (PT)
Entity Type:Individual
Prefix:MRS
First Name:LOUISE
Middle Name:
Last Name:AUDET
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 1:196 E ELM AVE STE 101
Mailing Address - Street 2:PO BOX 616
Mailing Address - City:COALINGA
Mailing Address - State:CA
Mailing Address - Zip Code:93210-2801
Mailing Address - Country:US
Mailing Address - Phone:559-935-9697
Mailing Address - Fax:
Practice Address - Street 1:196 E ELM AVE STE 101
Practice Address - Street 2:
Practice Address - City:COALINGA
Practice Address - State:CA
Practice Address - Zip Code:93210-2801
Practice Address - Country:US
Practice Address - Phone:559-935-9697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-13
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT21342225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist