Provider Demographics
NPI:1528826583
Name:GAUTHREAUX, PAMELA ANN (MSPT)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANN
Last Name:GAUTHREAUX
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2846
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71273-2846
Mailing Address - Country:US
Mailing Address - Phone:318-224-8994
Mailing Address - Fax:
Practice Address - Street 1:523 E 6TH ST
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4007
Practice Address - Country:US
Practice Address - Phone:870-201-2222
Practice Address - Fax:870-201-2717
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT796225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist