Provider Demographics
NPI:1649555921
Name:GIGANTE, JEROME P
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:P
Last Name:GIGANTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10612 GOLD COAST CT
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-4702
Mailing Address - Country:US
Mailing Address - Phone:318-581-3311
Mailing Address - Fax:
Practice Address - Street 1:10612 GOLD COAST CT
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71115-4702
Practice Address - Country:US
Practice Address - Phone:318-581-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07326F225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist