Provider Demographics
NPI:1902092612
Name:MENARD, JEREMY JAMES (P T)
Entity Type:Individual
Prefix:PROF
First Name:JEREMY
Middle Name:JAMES
Last Name:MENARD
Suffix:
Gender:M
Credentials:P T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 ROBLEY DR
Mailing Address - Street 2:SUITE 135
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-5200
Mailing Address - Country:US
Mailing Address - Phone:337-991-0102
Mailing Address - Fax:337-991-0032
Practice Address - Street 1:701 ROBLEY DR
Practice Address - Street 2:SUITE 135
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-5200
Practice Address - Country:US
Practice Address - Phone:337-991-0102
Practice Address - Fax:337-991-0032
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07242225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist