Provider Demographics
NPI:1528156825
Name:DRECKTRAH, SUE ELLEN (PT)
Entity type:Individual
Prefix:MISS
First Name:SUE
Middle Name:ELLEN
Last Name:DRECKTRAH
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 1:841 ORION AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-1309
Mailing Address - Country:US
Mailing Address - Phone:504-957-6456
Mailing Address - Fax:504-828-5120
Practice Address - Street 1:841 ORION AVE
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-1309
Practice Address - Country:US
Practice Address - Phone:504-957-6456
Practice Address - Fax:504-828-5120
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11502251X0800X
LA1150R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic