Individual
MARY BETH CHURBOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
308 SIDNEY MARTIN RD, ROOM 174, LAFAYETTE, LA 70507-4544
(337) 233-3665
Mailing address
2002 JOHNSON ST, SUITE 100, JENNINGS, LA 70546-3640
(337) 824-4547
(337) 824-4548
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
00325
LA
Other
Enumeration date
06/29/2015
Last updated
06/29/2015
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