Provider Demographics
NPI:1487707477
Name:MAYES, SUE A (PTA)
Entity type:Individual
Prefix:MRS
First Name:SUE
Middle Name:A
Last Name:MAYES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 PARK RD
Mailing Address - Street 2:
Mailing Address - City:KINDER
Mailing Address - State:LA
Mailing Address - Zip Code:70648-5306
Mailing Address - Country:US
Mailing Address - Phone:337-738-2378
Mailing Address - Fax:337-738-5850
Practice Address - Street 1:509 PARK RD
Practice Address - Street 2:
Practice Address - City:KINDER
Practice Address - State:LA
Practice Address - Zip Code:70648-5306
Practice Address - Country:US
Practice Address - Phone:337-738-2378
Practice Address - Fax:337-738-5850
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAP. T. A1961G225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAP. T. A1961GOtherPHYSICAL THERAPIST ASSIST