Provider Demographics
NPI:1932140340
Name:BAUDRY, RICHARD E (PT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:E
Last Name:BAUDRY
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 1:220 HOLLYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-3920
Mailing Address - Country:US
Mailing Address - Phone:504-833-4240
Mailing Address - Fax:
Practice Address - Street 1:1311 GAUSE BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-3015
Practice Address - Country:US
Practice Address - Phone:985-649-6577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1858225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5X686BD21OtherMEDICARE PTAN
LA5X686BD21OtherMEDICARE PTAN
LA5X686CS21Medicare UPIN
LA5X686BD21Medicare PIN
LA5X686Medicare ID - Type Unspecified
LA5X686CS21Medicare PIN