Individual
MRS. MARY GRACE JORDAN DOUGLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
8397 HIGHWAY 23 STE 101, BELLE CHASSE, LA 70037-2609
(504) 398-2004
Mailing address
358 PRINCETON CIR, BELLE CHASSE, LA 70037-1311
(256) 527-1177
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
10836F
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14961836
CAQH
LA
Enumeration date
09/03/2020
Last updated
03/23/2022
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