Individual
MARY K DERANGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
2335 CHURCH ST STE G, ZACHARY, LA 70791-2700
(225) 654-8208
(225) 654-4642
Mailing address
2335 CHURCH ST STE G, ZACHARY, LA 70791-2700
(225) 654-8208
(225) 654-4642
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
07557
LA
225X00000X
Occupational Therapist
OTT.200306
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07557
PHYSICAL THERAPY LICENSE
LA
Enumeration date
05/14/2009
Last updated
07/20/2021
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