Provider Demographics
NPI:1285160317
Name:GUILBEAU, NICHOLAS I
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:GUILBEAU
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:NICHOLAS
Other - Middle Name:
Other - Last Name:GUILBEAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:710 PRAIRIE ST
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:LA
Mailing Address - Zip Code:71295-2630
Mailing Address - Country:US
Mailing Address - Phone:318-435-3882
Mailing Address - Fax:318-435-4306
Practice Address - Street 1:710 PRAIRIE ST
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:LA
Practice Address - Zip Code:71295-2630
Practice Address - Country:US
Practice Address - Phone:318-435-3882
Practice Address - Fax:318-435-4306
Is Sole Proprietor?:No
Enumeration Date:2017-05-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09623225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist