Provider Demographics
NPI:1548326846
Name:LEMOINE, JODI NICOLE BRIDGES (PT)
Entity type:Individual
Prefix:MRS
First Name:JODI
Middle Name:NICOLE BRIDGES
Last Name:LEMOINE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 JENNIFER LN
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-4213
Mailing Address - Country:US
Mailing Address - Phone:504-906-3739
Mailing Address - Fax:
Practice Address - Street 1:210 W JUDGE PEREZ DR
Practice Address - Street 2:
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-4902
Practice Address - Country:US
Practice Address - Phone:504-906-3739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06834R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAPT 06834ROtherPHYSICAL THERAPY LICENSE
LA4H826Medicare ID - Type Unspecified