Provider Demographics
NPI:1831444587
Name:ALLEN, ANNE BOURGEOIS (DPT)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:BOURGEOIS
Last Name:ALLEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:FRANCIS
Other - Last Name:BOURGEOIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:512 BRANDYWINE BLVD
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-6833
Mailing Address - Country:US
Mailing Address - Phone:985-414-3801
Mailing Address - Fax:
Practice Address - Street 1:808 BAYOU LN
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4906
Practice Address - Country:US
Practice Address - Phone:985-447-3164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08059225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist