Provider Demographics
NPI:1881746766
Name:UDOM, IME EMERSON (PT, DPT, PHD)
Entity type:Individual
Prefix:DR
First Name:IME
Middle Name:EMERSON
Last Name:UDOM
Suffix:
Gender:M
Credentials:PT, DPT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 58
Mailing Address - Street 2:
Mailing Address - City:CHAUVIN
Mailing Address - State:LA
Mailing Address - Zip Code:70344-0058
Mailing Address - Country:US
Mailing Address - Phone:985-594-8332
Mailing Address - Fax:985-594-8389
Practice Address - Street 1:5108 HWY 56
Practice Address - Street 2:
Practice Address - City:CHAUVIN
Practice Address - State:LA
Practice Address - Zip Code:70344-8316
Practice Address - Country:US
Practice Address - Phone:985-594-8332
Practice Address - Fax:985-594-8389
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA02072F225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5X656Medicare ID - Type Unspecified