Provider Demographics
NPI:1023348208
Name:LAGARDE, STANLEY JON (PT)
Entity type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:JON
Last Name:LAGARDE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:29301 N DIXIE RANCH RD
Mailing Address - Street 2:
Mailing Address - City:LACOMBE
Mailing Address - State:LA
Mailing Address - Zip Code:70445-5403
Mailing Address - Country:US
Mailing Address - Phone:985-871-4114
Mailing Address - Fax:985-871-4130
Practice Address - Street 1:2775 S COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-7961
Practice Address - Country:US
Practice Address - Phone:985-871-4114
Practice Address - Fax:985-871-4130
Is Sole Proprietor?:No
Enumeration Date:2010-01-11
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00756225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist