Provider Demographics
NPI:1952849705
Name:CABALLERO, CLINT A (DPT)
Entity Type:Individual
Prefix:
First Name:CLINT
Middle Name:A
Last Name:CABALLERO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5627 BANKERS AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-2619
Mailing Address - Country:US
Mailing Address - Phone:225-927-3000
Mailing Address - Fax:225-927-4183
Practice Address - Street 1:5627 BANKERS AVE STE 1
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-2619
Practice Address - Country:US
Practice Address - Phone:225-927-3000
Practice Address - Fax:225-927-4183
Is Sole Proprietor?:No
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08421225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA08421OtherLOUISIANA STATE LICENSE