Basic Information
| Provider Information | |||||||||
| NPI: | 1083191795 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOOPER | ||||||||
| FirstName: | VIRGINIA | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 45109 HOOPER LN | ||||||||
| Address2: | |||||||||
| City: | SAINT AMANT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707743673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2259313592 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8080 BLUEBONNET BLVD STE 10 | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708107827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2254087990 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2018 | ||||||||
| LastUpdateDate: | 07/25/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | A7977 | LA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.