Individual
CODI BOUDREAUX WAGUESPACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
508 N ACADIA RD, THIBODAUX, LA 70301-4862
(985) 448-5888
(985) 448-0589
Mailing address
508 N ACADIA RD, THIBODAUX, LA 70301-4862
(985) 448-5888
(985) 448-0589
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
07954
LA
Other
Enumeration date
09/28/2010
Last updated
02/20/2013
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