Provider Demographics
NPI:1871605543
Name:KINNARD, MARK JAMES (LPT)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:JAMES
Last Name:KINNARD
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 BELANGER ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4412
Mailing Address - Country:US
Mailing Address - Phone:985-879-4388
Mailing Address - Fax:985-879-2854
Practice Address - Street 1:1014 BELANGER ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4412
Practice Address - Country:US
Practice Address - Phone:985-879-4388
Practice Address - Fax:985-879-2854
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA 03212225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4C094CA71Medicare ID - Type Unspecified