Provider Demographics
NPI:1912035411
Name:PICKERING, LOUISE BOISVERT (PT)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:BOISVERT
Last Name:PICKERING
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 1:4319 VALOMA PL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-3734
Mailing Address - Country:US
Mailing Address - Phone:858-455-6818
Mailing Address - Fax:
Practice Address - Street 1:3020 CHILDREN'S WAY MC5068
Practice Address - Street 2:CHILDREN HOSPITAL AND HEALTH
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123
Practice Address - Country:US
Practice Address - Phone:858-966-5829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 16524225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist