Provider Demographics
NPI:1821153016
Name:MARCEAUX, STEPHANIE LYNN (PT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYNN
Last Name:MARCEAUX
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 1:1329A HORRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70668-4531
Mailing Address - Country:US
Mailing Address - Phone:337-589-2626
Mailing Address - Fax:337-589-2621
Practice Address - Street 1:1329A HORRIDGE ST
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:LA
Practice Address - Zip Code:70668-4531
Practice Address - Country:US
Practice Address - Phone:337-589-2626
Practice Address - Fax:337-589-2621
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPT02051225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1821153016OtherGROUP MEMBER NPI
LA1316264153OtherGROUP NPI
LA5DT76OtherGROUP PTAN
LA5X761DT76OtherGROUP MEMBER PTAN