Provider Demographics
NPI:1952525735
Name:KLEINE STAARMAN, JEROEN F (PT)
Entity Type:Individual
Prefix:MR
First Name:JEROEN
Middle Name:F
Last Name:KLEINE STAARMAN
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 1:3939 HOUMA BLVD STE 21
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2921
Mailing Address - Country:US
Mailing Address - Phone:504-885-6464
Mailing Address - Fax:504-247-0562
Practice Address - Street 1:3939 HOUMA BLVD STE 21
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2921
Practice Address - Country:US
Practice Address - Phone:504-885-6464
Practice Address - Fax:504-247-0562
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA02357F225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA349908400OtherUS DEPT OF LABOR NUMBER