Individual
MISTY ENTREMONT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
18059 OLD RESERVE DR, PRAIRIEVILLE, LA 70769-5547
(979) 487-8798
Mailing address
18059 OLD RESERVE DR, PRAIRIEVILLE, LA 70769-5547
(979) 487-8798
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A9033R
LA
Other
Enumeration date
10/16/2015
Last updated
10/16/2015
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