Provider Demographics
NPI:1053570333
Name:FROST, CONNIE (PT)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:FROST
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:M
Other - Last Name:CAVDAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 848766
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:LA
Mailing Address - Zip Code:02284-8766
Mailing Address - Country:US
Mailing Address - Phone:504-347-5421
Mailing Address - Fax:504-340-5171
Practice Address - Street 1:4633 WICHERS DR
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3002
Practice Address - Country:US
Practice Address - Phone:504-347-0733
Practice Address - Fax:504-378-9329
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA02740225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA02740OtherPT LICENSE
1053570333OtherBLUE CROSS/BLUE SHIELD