Provider Demographics
NPI:1528244803
Name:MCDOUGALL, KARLIE RAE (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:KARLIE
Middle Name:RAE
Last Name:MCDOUGALL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MS
Other - First Name:KARLIE
Other - Middle Name:RAE
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:19345 SUNSHINE AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-8834
Mailing Address - Country:US
Mailing Address - Phone:985-809-3940
Mailing Address - Fax:985-809-3942
Practice Address - Street 1:19345 SUNSHINE AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-8834
Practice Address - Country:US
Practice Address - Phone:985-809-3940
Practice Address - Fax:985-809-3942
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT23825225100000X
LA07581R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3B154BC89Medicare PIN