Provider Demographics
NPI:1255514402
Name:FONTENOT HORNSBY, ELIZABETH ASHLEY (MPT)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ASHLEY
Last Name:FONTENOT HORNSBY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MISS
Other - First Name:E.
Other - Middle Name:ASHLEY
Other - Last Name:FONTENOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:PO BOX 4015
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70606-4015
Mailing Address - Country:US
Mailing Address - Phone:337-722-2997
Mailing Address - Fax:337-270-2546
Practice Address - Street 1:2000 SOUTHWOOD DR
Practice Address - Street 2:SUITE B
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605
Practice Address - Country:US
Practice Address - Phone:337-722-2997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07331225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist