Provider Demographics
NPI:1720138506
Name:MANCUSO, FRAN C (PT)
Entity Type:Individual
Prefix:
First Name:FRAN
Middle Name:C
Last Name:MANCUSO
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 1:1103 KALISTE SALOOM ROAD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508
Mailing Address - Country:US
Mailing Address - Phone:337-289-9129
Mailing Address - Fax:337-289-9131
Practice Address - Street 1:1103 KALISTE SALOOM ROAD
Practice Address - Street 2:SUITE 104
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508
Practice Address - Country:US
Practice Address - Phone:337-289-9129
Practice Address - Fax:337-289-9131
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00589225100000X
LA589225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA7500296OtherAETNA PPO
LA2252789OtherAETNA HMO