Basic Information
| Provider Information | |||||||||
| NPI: | 1346674405 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DICHARRY | ||||||||
| FirstName: | DAPHNE | ||||||||
| MiddleName: | ZIMMER | ||||||||
| NamePrefix: | |||||||||
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| Credential: | P.T. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | ZIMMER | ||||||||
| OtherFirstName: | DAPHNE | ||||||||
| OtherMiddleName: | MICHELE | ||||||||
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| OtherCredential: | P.T. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 8080 BLUEBONNET BLVD | ||||||||
| Address2: | SUITE 1000 | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708107827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2259242424 | ||||||||
| FaxNumber: | 2254087984 | ||||||||
| Practice Location | |||||||||
| Address1: | 625 S BURNSIDE AVE | ||||||||
| Address2: | UNIT 9 | ||||||||
| City: | GONZALES | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707373400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2256448510 | ||||||||
| FaxNumber: | 2256449736 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2013 | ||||||||
| LastUpdateDate: | 08/26/2013 | ||||||||
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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 | 08551 | LA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.