Provider Demographics
NPI:1356436760
Name:JANNEY, TODD TRUITT SR (PT)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:TRUITT
Last Name:JANNEY
Suffix:SR
Gender:M
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:PO BOX 408
Mailing Address - Street 2:
Mailing Address - City:PLAQUEMINE
Mailing Address - State:LA
Mailing Address - Zip Code:70765-0408
Mailing Address - Country:US
Mailing Address - Phone:225-687-2066
Mailing Address - Fax:225-687-2067
Practice Address - Street 1:59295 RIVER WEST DR
Practice Address - Street 2:STE H
Practice Address - City:PLAQUEMINE
Practice Address - State:LA
Practice Address - Zip Code:70764-6596
Practice Address - Country:US
Practice Address - Phone:225-687-2066
Practice Address - Fax:225-687-2067
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA01442225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1135321Medicaid
LA5X689CD04Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL/GROUP
LA5X689C492Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL/GROUP
LA5X689Medicare ID - Type UnspecifiedMEDICARE