Laetitia Bourgeon, DPT

Key facts

NPI

1508285289

Entity type

Individual (NPI type 1)

Primary specialty

Physical Therapist 225100000X

License

PT3735 (AR)

Practice address

3315 Pebble Beach Rd
Apt 5
Conway, AR 72034-8550

Phone

(501) 428-3249

NPI assigned

Apr 10, 2014

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 10, 2014.

{
    "created_epoch": "1397088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1397088000000",
    "number": "1508285289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3315 PEBBLE BEACH RD",
            "address_2": "APT 5",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720348550",
            "telephone_number": "501-428-3249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3315 PEBBLE BEACH RD",
            "address_2": "APT 5",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720348550",
            "telephone_number": "501-428-3249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURGEON",
        "first_name": "LAETITIA",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-04-10",
        "last_updated": "2014-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AR",
            "license": "PT3735",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Conway, AR · Physical Therapist in Arkansas