Provider Demographics
NPI:1548517808
Name:BOUE, DONNA (PT)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:BOUE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2901 RIDGELAKE DR
Mailing Address - Street 2:SUITE 209
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-4966
Mailing Address - Country:US
Mailing Address - Phone:504-309-0868
Mailing Address - Fax:504-309-0867
Practice Address - Street 1:2901 RIDGELAKE DR
Practice Address - Street 2:SUITE 209
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-4966
Practice Address - Country:US
Practice Address - Phone:504-309-0868
Practice Address - Fax:504-309-0867
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA00732225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist