Provider Demographics
NPI:1538427828
Name:MATHERNE, LORI WAGUESPACK (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:WAGUESPACK
Last Name:MATHERNE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:104 E BAYOU RD STE C
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-3036
Mailing Address - Country:US
Mailing Address - Phone:985-446-3736
Mailing Address - Fax:985-446-3701
Practice Address - Street 1:104 E BAYOU RD STE C
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-3036
Practice Address - Country:US
Practice Address - Phone:985-446-3736
Practice Address - Fax:985-446-3701
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08317225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist