Provider Demographics
NPI:1255517736
Name:ARDOIN, DEIDRE ANN (PT, MSPT)
Entity type:Individual
Prefix:
First Name:DEIDRE
Middle Name:ANN
Last Name:ARDOIN
Suffix:
Gender:F
Credentials:PT, MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 NELSON RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-4118
Mailing Address - Country:US
Mailing Address - Phone:337-475-4020
Mailing Address - Fax:337-475-4720
Practice Address - Street 1:4200 NELSON RD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-4118
Practice Address - Country:US
Practice Address - Phone:337-475-4020
Practice Address - Fax:337-475-4720
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA03578R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist