Provider Demographics
NPI:1902855893
Name:GILBERT-FONTANA, LORAIN (PT)
Entity Type:Individual
Prefix:PROF
First Name:LORAIN
Middle Name:
Last Name:GILBERT-FONTANA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:PROF
Other - First Name:LORAIN
Other - Middle Name:
Other - Last Name:GILBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:9029 REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70510-2173
Mailing Address - Country:US
Mailing Address - Phone:337-892-0725
Mailing Address - Fax:337-893-6607
Practice Address - Street 1:9029 REDWOOD RD
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-2173
Practice Address - Country:US
Practice Address - Phone:337-892-0725
Practice Address - Fax:337-893-6607
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00431R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5X923Medicare ID - Type UnspecifiedMEDICARE NUMBER