Nicole Marie Fabre, DPT
Individual provider Active NPI Physical Therapist · Port Allen, LA
NPI 1902076649 · NPPES record last updated Mar 22, 2023
Key facts
- NPI
- 1902076649
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 07341 (LA)
- Practice address
- 4171 Hwy 1 S. Ste 10
Port Allen, LA 70767 - Phone
- (225) 416-0333
- Fax
- (225) 416-0332
- NPI assigned
- Mar 10, 2008
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Westside Physical Therapy LLC
Practice addresses (Care Compare)
4171 Hwy 1 S
Suite 10
Port Allen, LA 70767-5822
Phone (225) 416-0333
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110411000360 | LA | Practitioner - Physical Therapist in Private Practice | 7012191356 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7341 | LA | MD | Professional Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 07341 | LA | Yes |
Addresses
Primary practice location
4171 Hwy 1 S. Ste 10
Port Allen, LA 70767
Mailing address
4171 Hwy 1 S. Ste 10
Port Allen, LA 70767
Phone (225) 416-0333
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 721512274 | Other | LA | TAX ID |
| 1693081 | Medicaid | LA | |
| 2520423 | Medicaid | LA | |
| 721342481 | Other | LA | TAX ID |
Other names
- Nicole Marie Seneca
Other providers in Port Allen, LA
- Raven E Dunlap
- Justin Deanthony Dyer
- Eagle Transit, LLC
- Empowerment Consultants, LLC
- James Escort
- Gerard Fernand Falgoust
- Amanda Renee Forbes
- Fresenius Medical Care Capital City, LLC
- G'S Speech Corner LLC
- Robyn Keegan Gilmore
All providers in Port Allen, LA · Physical Therapist in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 22, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.