Provider Demographics
NPI:1821328642
Name:LAMBOUSY, ERIC P (PT)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:P
Last Name:LAMBOUSY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1322 ELTON RD
Mailing Address - Street 2:SUITE I
Mailing Address - City:JENNINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70546-4100
Mailing Address - Country:US
Mailing Address - Phone:337-824-5488
Mailing Address - Fax:337-824-5494
Practice Address - Street 1:1322 ELTON ROAD
Practice Address - Street 2:SUITE I
Practice Address - City:JENNINGS
Practice Address - State:LA
Practice Address - Zip Code:70546
Practice Address - Country:US
Practice Address - Phone:337-824-5488
Practice Address - Fax:337-824-5494
Is Sole Proprietor?:No
Enumeration Date:2009-12-29
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA03602225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA$$$$$$$$$AOtherBLUE CROSS BLUE SHEILD OF LA
LA$$$$$$$$$AOtherBLUE CROSS BLUE SHEILD OF LA