Provider Demographics
NPI:1881793867
Name:YURATICH, VIRGINIA FAIRCHILD (MSPT)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:FAIRCHILD
Last Name:YURATICH
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MRS
Other - First Name:GINNY
Other - Middle Name:FAIRCHILD
Other - Last Name:YURATICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSPT
Mailing Address - Street 1:801 E JUDGE PEREZ DR
Mailing Address - Street 2:STE A
Mailing Address - City:CHALMETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70043-5353
Mailing Address - Country:US
Mailing Address - Phone:504-278-7567
Mailing Address - Fax:504-278-7569
Practice Address - Street 1:801 E JUDGE PEREZ DR
Practice Address - Street 2:STE A
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-5353
Practice Address - Country:US
Practice Address - Phone:504-278-7567
Practice Address - Fax:504-278-7569
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05064225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA05064OtherSTATE LICENSE NUMBER
LA05064OtherSTATE LICENSE NUMBER