Individual
HEATHER BOURLET
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
41043 SNOWBALL CIR, PONCHATOULA, LA 70454-8420
(239) 293-5388
Mailing address
41043 SNOWBALL CIR, PONCHATOULA, LA 70454-8420
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A10249
LA
Other
Enumeration date
07/22/2019
Last updated
07/22/2019
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