Provider Demographics
NPI:1922392380
Name:DESSAUER, KEVIN PATIN
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:PATIN
Last Name:DESSAUER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2721 N CAUSEWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-6051
Mailing Address - Country:US
Mailing Address - Phone:504-841-0150
Mailing Address - Fax:504-841-0180
Practice Address - Street 1:2721 N CAUSEWAY BLVD
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-6051
Practice Address - Country:US
Practice Address - Phone:504-841-0150
Practice Address - Fax:504-841-0180
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08076225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist