Provider Demographics
NPI:1124699327
Name:DUPRE, SADIE LANE (PT, DPT)
Entity type:Individual
Prefix:
First Name:SADIE
Middle Name:LANE
Last Name:DUPRE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 SHADOWS LN
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-6530
Mailing Address - Country:US
Mailing Address - Phone:225-231-3808
Mailing Address - Fax:
Practice Address - Street 1:1227 E HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-4761
Practice Address - Country:US
Practice Address - Phone:225-647-2060
Practice Address - Fax:225-647-2062
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10878225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist