Provider Demographics
NPI:1205890456
Name:FILIATREAU, LETICIA JO (PT)
Entity type:Individual
Prefix:MRS
First Name:LETICIA
Middle Name:JO
Last Name:FILIATREAU
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:LETICIA
Other - Middle Name:JO
Other - Last Name:BALLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:115 S SALEM DR
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-1762
Mailing Address - Country:US
Mailing Address - Phone:502-350-0880
Mailing Address - Fax:502-350-3640
Practice Address - Street 1:115 S SALEM DR
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-1762
Practice Address - Country:US
Practice Address - Phone:502-350-0880
Practice Address - Fax:502-350-3640
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4840225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist