Provider Demographics
NPI:1932518446
Name:AZCUNA, THERESA (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MISS
First Name:THERESA
Middle Name:
Last Name:AZCUNA
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 74587
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70874-4587
Mailing Address - Country:US
Mailing Address - Phone:225-810-3518
Mailing Address - Fax:225-454-6018
Practice Address - Street 1:3676 HARDING BLVD
Practice Address - Street 2:SUITE B &C
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70807-5258
Practice Address - Country:US
Practice Address - Phone:225-454-6005
Practice Address - Fax:225-454-6018
Is Sole Proprietor?:No
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA01148F225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist