Provider Demographics
NPI:1831424340
Name:IMVRIOTIS, VALENTINI (PT)
Entity type:Individual
Prefix:MS
First Name:VALENTINI
Middle Name:
Last Name:IMVRIOTIS
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:P.O. BOX 61651
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70596
Mailing Address - Country:US
Mailing Address - Phone:337-234-1182
Mailing Address - Fax:337-234-8845
Practice Address - Street 1:101 PARK WEST
Practice Address - Street 2:SUITE D
Practice Address - City:SCOTT
Practice Address - State:LA
Practice Address - Zip Code:70583
Practice Address - Country:US
Practice Address - Phone:337-234-1182
Practice Address - Fax:337-234-8845
Is Sole Proprietor?:No
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA03267F225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist