Provider Demographics
NPI:1679711139
Name:GUIDRY, JOHN PAUL (PT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:GUIDRY
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 1:5200 HIGHWAY 22
Mailing Address - Street 2:STE 6
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-2563
Mailing Address - Country:US
Mailing Address - Phone:337-274-3639
Mailing Address - Fax:985-792-7685
Practice Address - Street 1:5200 HIGHWAY 22
Practice Address - Street 2:STE 6
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-2563
Practice Address - Country:US
Practice Address - Phone:337-274-3639
Practice Address - Fax:985-792-7685
Is Sole Proprietor?:No
Enumeration Date:2009-01-21
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07689R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist