Active NPI
Tamara L Bordelon, PT
- Physical Therapist
- Monroe, LA
National Provider Identifier
1730192501
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 00718
- Practice address
- 1325 Louisville Ave
Monroe, LA 71201-6021 - Phone
- (318) 807-1500
- Fax
- (318) 807-1504
- NPI assigned
- Aug 14, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 00718 | LA | Primary |
Addresses
Primary practice location
1325 Louisville Ave
Monroe, LA 71201-6021
Mailing address
130 Desiard St Ste 355
Monroe, LA 71201-7363
Phone (318) 807-7875
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 104370500 | Other | LA | FED EMP W/C |
| 2387146 | Medicaid | LA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00718 | LA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Xcel Therapy Solutions, LLC | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Comprehensive Outpatient Rehabilitation Facility (CORF)
- Winnsboro, LA
- NPI 1497900476
Physical Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155513600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560384000000",
"number": "1730192501",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "130 DESIARD ST STE 355",
"city": "MONROE",
"state": "LA",
"postal_code": "712017363",
"telephone_number": "318-807-7875",
"fax_number": "318-812-6603"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1325 LOUISVILLE AVE",
"city": "MONROE",
"state": "LA",
"postal_code": "712016021",
"telephone_number": "318-807-1500",
"fax_number": "318-807-1504"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BORDELON",
"first_name": "TAMARA",
"middle_name": "L",
"name_prefix": "Mrs.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-14",
"last_updated": "2019-06-13",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "LA",
"license": "00718",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FED EMP W/C",
"identifier": "104370500",
"state": "LA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2387146",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Monroe, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.