Ellen Dean Pedeaux, PT, DPT
Individual provider Active NPI Physical Therapist · Bossier City, LA
NPI 1962078709 · NPPES record last updated Feb 1, 2024
Key facts
- NPI
- 1962078709
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 09898 (LA)
- Practice address
- 4970 Barksdale Blvd Ste 900
Bossier City, LA 71112-4677 - Phone
- (318) 747-8892
- Fax
- (318) 747-8893
- NPI assigned
- Jun 2, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240213001767 | LA | Practitioner - Physical Therapist in Private Practice | 9032552484 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Brewer Physical Therapy & Associates LLC | Current |
Accepting new patients | |
| Select Physical Therapy Texas Limited Partnership | Past |
Accepting new patients | |
| Casa Pediatric Care LLC | Past | Accepting new patients |
Locations
4970 Barksdale Blvd
Ste 900
Bossier City, LA 71112
Phone (318) 747-8892
663 Jordan St
Shreveport, LA 71101
Phone (318) 222-8892
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | |||
| Physical Therapist | 225100000X | 09898 | LA | Yes |
Addresses
Primary practice location
4970 Barksdale Blvd Ste 900
Bossier City, LA 71112-4677
Mailing address
663 Jordan St
Shreveport, LA 71101-4748
Phone (318) 222-8892
Other practice location 1
663 Jordan St
Shreveport, LA 71101-4748
Phone (318) 222-8892 ext. 1
Other practice location 2
310 Royal St
Natchitoches, LA 71457-5709
Phone (318) 210-6836
Other names
- Ellen Andries Dean
Other providers in Bossier City, LA
- Daniel L. Payne
- Peaceful Mind Home Care Service,LLC
- Matthew Pearce
- Jentry McClard Pearson
- Kimberly Akers Pearson
- Pediatric Dental Partners, LLP
- Mardosha Peek
- Tracie Pendarvis
- Daniel Ray Pennywell
- Crystal Peoples-Mims
All providers in Bossier City, 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 Feb 1, 2024. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.