Provider Demographics
NPI:1437988714
Name:TREMBLAY, THERESA (DPT)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:TREMBLAY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 PERCY BROWN RD APT 824
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-6772
Mailing Address - Country:US
Mailing Address - Phone:978-257-1153
Mailing Address - Fax:
Practice Address - Street 1:2614 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:LA
Practice Address - Zip Code:70121-3828
Practice Address - Country:US
Practice Address - Phone:504-464-8590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-26
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11848225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist