Basic Information
| Provider Information | |||||||||
| NPI: | 1275700767 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCARLE | ||||||||
| FirstName: | KRISTIN | ||||||||
| MiddleName: | KENT | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1624 AUDUBON PKWY | ||||||||
| Address2: | |||||||||
| City: | MADISONVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704473262 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252414212 | ||||||||
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| Practice Location | |||||||||
| Address1: | 770 GAUSE BLVD STE F | ||||||||
| Address2: | |||||||||
| City: | SLIDELL | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704582855 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9856499123 | ||||||||
| FaxNumber: | 9856499129 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2008 | ||||||||
| LastUpdateDate: | 04/15/2019 | ||||||||
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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 | 225100000X | 05176 | LA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.