Provider Demographics
NPI:1912511858
Name:HEBERT, JACQUELYNN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELYNN
Middle Name:
Last Name:HEBERT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:JACQUELYNN
Other - Middle Name:
Other - Last Name:SANDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1422
Mailing Address - Street 2:
Mailing Address - City:NATALBANY
Mailing Address - State:LA
Mailing Address - Zip Code:70451-1422
Mailing Address - Country:US
Mailing Address - Phone:225-209-7140
Mailing Address - Fax:225-567-6847
Practice Address - Street 1:19089 FLORIDA BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:LA
Practice Address - Zip Code:70711-3603
Practice Address - Country:US
Practice Address - Phone:225-209-7140
Practice Address - Fax:225-567-6847
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA7444225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant