Provider Demographics
NPI:1841061751
Name:BAUMGARTNER, ADRIENNE COURET (PT)
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:COURET
Last Name:BAUMGARTNER
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 1:222 CALUMET DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-9110
Mailing Address - Country:US
Mailing Address - Phone:985-774-4322
Mailing Address - Fax:
Practice Address - Street 1:100 CHRISTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-4606
Practice Address - Country:US
Practice Address - Phone:985-340-0102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06648225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist