Provider Demographics
NPI:1124308234
Name:PREVOST, KATHERINE CLAIRE (DPT)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:CLAIRE
Last Name:PREVOST
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4150 NELSON RD
Mailing Address - Street 2:SUITE C12
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-4148
Mailing Address - Country:US
Mailing Address - Phone:337-990-5621
Mailing Address - Fax:337-990-5623
Practice Address - Street 1:4141 COMMON ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70607-4501
Practice Address - Country:US
Practice Address - Phone:337-990-5621
Practice Address - Fax:337-990-5623
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07815225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist