Provider Demographics
NPI:1245071273
Name:MATHERNE, REMI LEIGH (PT)
Entity type:Individual
Prefix:
First Name:REMI
Middle Name:LEIGH
Last Name:MATHERNE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:476 FALCONER DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-8235
Mailing Address - Country:US
Mailing Address - Phone:985-871-7878
Mailing Address - Fax:985-871-9355
Practice Address - Street 1:476 FALCONER DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-8235
Practice Address - Country:US
Practice Address - Phone:985-871-7878
Practice Address - Fax:985-871-9355
Is Sole Proprietor?:No
Enumeration Date:2024-06-04
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11791225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist