Provider Demographics
NPI:1881953933
Name:DOERLE, EDWARD AVERY (PT)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:AVERY
Last Name:DOERLE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 DULLES DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-2652
Mailing Address - Country:US
Mailing Address - Phone:337-981-9182
Mailing Address - Fax:337-988-3441
Practice Address - Street 1:1220 BERARD ST STE B
Practice Address - Street 2:
Practice Address - City:BREAUX BRIDGE
Practice Address - State:LA
Practice Address - Zip Code:70517-4865
Practice Address - Country:US
Practice Address - Phone:337-332-6120
Practice Address - Fax:337-332-5537
Is Sole Proprietor?:No
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08287225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA08287OtherLA PHYSICAL THERAPY ASSOCIATION